Introduction: Pancreatic fistula develops in up to 40% patients following ODP of which 9.7 to 23% of patients have ISGPS grade B or C (CR-POPF). However factors responsible for fistula formation are poorly understood. We analyzed whether different surgical techniques for pancreatic transection and remnant management have role in PF formation after ODP. Methods: This is a retrospective study of patients who underwent ODP at 3 centers (one each in Central, North and Western India) over 7 - 10 years. CR-POPF was the main outcome measure. Operative technique: Following initial exploration, pancreatic tail and body was mobilized at least 2-3 cm central to designated transection line. Pancreas was then transected by either scalpel or monopolar electrosurgical energy (MEE). The main pancreatic duct (MPD) in remnant was selectively sutured by PDS 4-0/5-0. The pancreatic remnant was reinforced by sutures or left open. Results: Study group comprised of 42 ODP patients (26 males: 16 females; mean age 47.5 years). Of these 6 (14.3%) developed PF and 5 (11.9%) developed CR-POPF). Selective suture ligation of MPD was performed in 38 (90.4%) patients. Of the technical factors analyzed spleen preservation, method of pancreatic transection (scalpel versus MEE) and remnant reinforcement (none versus sutures) had no significant impact on development of PF. The demographic data, indications, technical details and outcomes are summarized in Table1. Conclusion: Selective suture closure of MPD resulted in low PF & CR-POPF rates in our study. Parenchymal transection technique and suture reinforcement of remnant had no impact on PF rates.PP04-073Operative details & outcomes of open distal pancreatectomy (n=42)DiagnosisCarcinoma / NET / Cystic tumor / Others07 / 10 / 11 / 14Operative detailsSpleen preservation: Yes / No07 / 35p=1Pancreatic transection: Scalpel / MEE / Stapler18 / 23 / 01p=0.74 (stapled excluded)Main pancreatic duct: Sutured / Duval / Stapled / Not localized38 / 02 / 01 / 01Remnant reinforcement (suture): - Yes / No25 / 17p=0.70Median surgery duration (range)250 (120-360) minOutcomesPancreatic fistula (ISGPF): A / B / C01 / 02 / 03Median LOS (range)7 (5-11) daysMortality01(2.3%) (Pneumonia) Open table in a new tab