Distal Pancreatectomy Utilizing a Flexible Stapler Closure Eliminates the Risk of Pancreas-Related Factors for Postoperative Pancreatic Fistula

Abstract

Objectives: To identify the risk factors for clinically relevant pancreatic fistula after distal pancreatectomy with a flexible cartridge stapler, TL60. Methods: Forty consecutive patients who underwent a distal pancreatectomy by the TL60 stapler were retrospectively reviewed in association with postoperative complications. Results: The overall morbidity rate was 43% (17 patients), and mortality was null. Pancreatic fistula was the most frequent postoperative complication, seen in 11 patients (27.5%): grade A in 4 (10%) and grade B in 7 (17.5%). No grade C pancreatic fistula was observed. Univariate analyses of risk factors demonstrated that pancreas-related factors, including diabetes mellitus, thickness and texture of the pancreatic parenchyma, transection line for the pancreas, pancreatic duct ligation, and use of artificial patches had no impact on the occurrence of pancreatic fistula. A multivariable logistic regression analysis identified operative time (≥300 min) as the only notable predictor of clinically relevant pancreatic fistula (odds ratio = 3.253, 95% confidence interval 1.739-5.752; p = 0.031). Conclusion: Distal pancreatectomy with the use of the TL60 stapler eliminated the risk of pancreas-related factors for the occurrence of clinically relevant pancreatic fistula.

Risk factors for pancreatic fistula following distal pancreatectomy: a retrospective study of 211 consecutive patients

“…Lower levels of albumin are believed to be more likely to result in pancreatic leakage. In contrast, there was no significant difference in the level of the preoperative albumin between the two groups in our work, nor was it in the work of Kawabata [35]. We found that patients with higher DA are more prone to develop a POPF, and statistical analysis of the DA showed a difference between these 2 groups.…”

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

“…Several authors investigated the risk factors for POPF after DP with stapler closure [9,11,[22][23][24][25][26][27]. Most of them reported that a thick pancreas was a risk factor for POPF [9,11,22,24,25,27].…”

Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue

“…Although several techniques have been advocated to close the stump of the remnant pancreas, such as hand-sewn closure, stapler closure, ultrasonic dissection, seromuscular patches, and pancreaticoenteric anastomosis, it remains unclear which of these techniques is optimal [6][7][8][9][10]. Currently, stapler and hand-sewn closures are widely performed as standard techniques [11,12]. Although several studies have reported that stapler closure contributes to a reduction in PF after DP [13][14][15][16], a randomized clinical trial to test the efficacy of stapler closure in DP in comparison with hand-sewn closure (DISPACT trial) revealed that stapler closure did not significantly reduce the incidence of PF [17].…”