The  OBJECTIVE  is  to  study  the  effect  of application of different  pancreatic stump  closure techniques to  the  postoperative period,  the frequency and  severity  of postoperative complications including postoperative pancreatic fistulas  after distal pancreatectomies. MATERIAL AND METHODS.  The  clinical  material  consisted of 126  patients who  underwent distal  pancreatectomies  (isolated or  in  combination  with  surgical   interventions  on  the  adjacent organs of  the  abdominal cavity  and retroperitoneal space).  The  patients  were   divided  into  4  groups  depending  on  the  pancreatic  stump   closure  techniques (isolated suturing  of the  main  pancreatic duct  of the  pancreatic stump  with its omentization by gastrocolic omentum or local sealing its  by  hemostatic sponge  (control  group);  using  a  local  biological  glue  2-octylcyanoacrylate; using  the  Endoscopic Linear  Cutter  Echelon; external transduodenal  transnasal  drainage of the  enlarged main  pancreatic duct  of the  pancreatic stump). We  evaluated the  influence   of  different  pancreatic stump   closure techniques  after  distal  pancreatectomies on  the postoperative period  as well the  frequency and  severity  of postoperative pancreatic fistulas  depending on the  diameter of the main  pancreatic duct  of pancreatic stump.   RESULTS.  The  overall  rate  of postoperative  complications in the  control  group of patients was  45.8  %, and  was  due  to an  increase in the  frequency of specific  complications (35.4  %). The  most  frequent complication  in  the  control  group   of  patients  was   postoperative  pancreatic  fistulas   –  29.2   %.  The  statistically   significant decrease  of  frequency  and   severity   of  postoperative  complications,  frequency  and   severity   of  postoperative  pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were  revealed in comparison with the  control  group  of patients. There  was  no  hospital  mortality.  CONCLUSION. Distal  pancreatectomy with  «standard»  pancreatic stump   closure techniques  accompanied by  high  frequency and  severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after  distal  pancreatectomy led  to  a  decrease of  the  frequency and  severity   of  postoperative  complications, a decrease of the  frequency and  severity  of postoperative pancreatic fistulas,  and  a decrease of the  postoperative hospital-stay.

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.