A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy
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Published:2021-09-13
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Volume:
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ISSN:0930-2794
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Container-title:Surgical Endoscopy
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language:en
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Short-container-title:Surg Endosc
Author:
Landoni Luca,De Pastena Matteo,Fontana Martina,Malleo Giuseppe,Esposito Alessandro,Casetti Luca,Marchegiani Giovanni,Tuveri Massimiliano,Paiella Salvatore,Pea Antonio,Ramera Marco,Borin Alex,Giardino Alessandro,Frigerio Isabella,Girelli Roberto,Bassi Claudio,Butturini Giovanni,Salvia Roberto
Abstract
Abstract
Background
The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy.
Methods
Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay.
Results
Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2–20.0, p = 0.032).
Conclusion
The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.
Funder
Università degli Studi di Verona
Publisher
Springer Science and Business Media LLC
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