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Distal pancreatectomy: is staple closure beneficial?
Kunio Takeuchi1, Yasushi Tsuzuki, Tetsu Ando
1Department of Surgery, Tone Chuo Hospital, and Department of Surgery I, Gunma University School of Medicine, Gunma, Japan. yukinao@dream.ocn.ne.jp
Background:
Appropriate closure of the pancreatic remnant after distal pancreatectomy remains controversial. Data on distal pancreatectomy were reviewed to evaluate the effectiveness of staple closure compared with suture closure.
Methods:
Thirty-three patients underwent distal pancreatectomy between January 1994 and December 2001. They were subdivided according to the method of closure of the distal pancreatic stump: the staple group comprised 10 patients and the suture group comprised 23 patients. Charts were reviewed for the method of closure of the distal stump as well as for the serum and urinary amylase level, mortality and morbidity.
Results:
In the staple group, no patient developed a pancreatic fistula, whereas in the suture group, eight patients (33.3%) developed a pancreatic fistula (P = 0.0353). The serum amylase level (mean +/- SD) on the first postoperative day was 185 +/- 71 IU/L in the staple group and 499 +/- 461 IU/L in the suture group (P = 0.0413).
Conclusion:
Staple closure by means of a Powered Multifire Endo GIA 60 is a simple, quick and safe alternative to the standard suture closure technique, as it reduces the incidence of pancreatic fistula.