Transection using a reinforced stapler reduces the incidence of pancreatic fistula after distal pancreatectomy

Abstract

Purpose: The appropriate procedure for closure of the remnant pancreatic stump in distal pancreatectomy (DP) remains unresolved. The purpose of this study was to compare the incidence of pancreatic fistula (PF) among the 3 methods, and to determine the risk factors for PF after DP. Methods: Between July 2009 and December 2016, 66 patients underwent pancreatic stump closure with 1 of 3 methods: the clamp-crushing method (n = 26), ultrasonic scissors (n = 18), and a reinforced stapler (n = 22). Results: There were significant differences in the incidence of PF (clamp-crushing method [38%] vs ultrasonic scissors [61%] vs reinforced stapler [9%], p< 0.001), and in the incidence of postoperative intra-abdominal hemorrhage (clamp-crushing method [0%] vs ultrasonic scissors [17%] vs reinforced stapler [0%] p = 0.047). A multivariate analysis revealed that intraoperative blood loss (≥605 mL), pancreatic thickness (≥11 mm), and the stump closure method were independent risk factors for PF after DP (p = 0.03, p = 0.001, p=0.018 respectively). Conclusion: The use of a reinforced stapler for the transection of the pancreas can reduce PF after DP. Intraoperative blood loss (≥ 605 mL), pancreatic thickness (≥ 11 mm), and the stump closure method remained as independent risk factors for PF after DP.