Comparison of Outcomes with Stapler Versus Hand-Sewn Closure of the Pancreatic Stump following Minimally Invasive Distal Pancreatectomy: A Retrospective Cohort Study

Abstract

Background: Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear. Methods: Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition. Results: Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs. 51.1% and 4.4%, P = 0.078 and P = 0.223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 min vs. 222 min, P = 0.139), incidence of major complications (16.5% vs. 20.0%, P = 0.559), and mortality (0.2% vs. 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = 0.004, 0.006, and 0.001, respectively). Conclusion: The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.