Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy: a retrospective cohort study

作     者：Qian Tao Huang Kaiquan Chen Wen Bai Xueli Gao Shunliang Shen Yan Zhang Min Wu Jian Yu Jun Ma Tao Liang Tingbo 

作者机构：Department of Hepatobiliary and Pancreatic Surgery the First Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province Hangzhou China Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases Hangzhou China Zhejiang Provincial Key Laboratory of Pancreatic Disease Hangzhou China Cancer Center Zhejiang University Hangzhou China 

出 版 物：《胰腺病学杂志(英文)》 (Journal of Pancreatology)

年 卷 期：2024年第07卷第2期

页      面：106-110页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Innovation Center for the Study of Pancreatic Diseases ICSPD-ZJ Zhejiang Province National Key Research and Development Program of China, NKRDPC, (2019YFC1316000) National Key Research and Development Program of China, NKRDPC National Natural Science Foundation of China, NSFC, (82071748, 82188102) National Natural Science Foundation of China, NSFC 

主　　题：Distal pancreatectomy Minimally invasive surgery Outcome Postoperative pancreatic fistula Stapler closure 

摘      要：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 ***: 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 ***: 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 = .078 andP = .223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 vs 222 minutes,P = .139), incidence of major complications (16.5% vs 20.0%,P = .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 = .004, .006, and .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.