Analysis of closure of the pancreatic remnant after distal pancreatic resection.

ABSTRACT

BACKGROUND: The appropriate management of the pancreatic remnant following distal pancreatic resection remains a clinically relevant problem. We carried out a retrospective analysis which focused on this issue and compared the two favored techniques of suture and staple closure. PATIENTS AND METHODS: Forty-six patients underwent distal pancreatectomy between October 1999 and January 2006. The patients were retrospectively analysed based on the management of the remaining pancreatic gland. Thirty-seven patients had suture and nine patients had staple closure. The morbidity, mortality, incidence of pancreatic fistula, necessity of secondary surgical intervention, and the duration of hospital stay for the two groups were compared. Pancreatic fistula was considered according to the novel international standard definition (ISGPF). In addition, subgroup analysis of patients receiving octreotide was carried out. RESULTS: Overall, postoperative morbidity due to pancreatic fistula occurred in seven patients (19%) after suture and in one patient (11%) after staple closure (p = 0.54), with no deaths. The number of patients with surgical revision related to pancreatic leakage was two (5%) after suture closure vs no revision after staple closure (p = 0.65). The median number of total hospital days for the suture group was 19 (range 7-78 days) vs 21 (range 12-96 days) for the stapler group (p = 0.21). No significant benefit for the octreotide application could be determined. CONCLUSION: According to the data, no significant difference for either suture or stapler closure was observed, with the tendency for staple closure to be superior.