Usefulness of linear stapling device in distal pancreatic resection

Although the mortality rate related to pancreatic surgery has been reduced, postoperative pancreatic fistula (POPF) remains high. The rate of POPF is reportedly between 5 and 34%. The pancreatic stump is typically closed by hand using suture materials. Recently, linear stapling devices have been employed in pancreatic resection, but the efficacy and safety of this procedure remain uncertain.

Efficacy and safety were retrospectively analyzed for distal pancreatic resection using a linear stapling device in open and laparoscopic procedures starting from January 1999 (Group A: n=20), and perioperative data were compared with those for hand-sewn stump closure starting from January 1990 (Group B: n=28).

Mean operative times in Group A and Group B were 165 min and 200 min, respectively (p < 0.05). POPF was observed in two cases in Group A (10%) and 10 cases in Group B (35%) (p < 0.05). POPF was not observed in the three patients who underwent laparoscopic pancreatic resection with the linear stapling device. Mean hospital stay for Groups A and B was 14 days and 20 days, respectively (p < 0.05). In POPF patients, no clinical symptoms were observed, but drains were removed 10 postoperative days later than in patients without POPF, from whom drains were withdrawn at 7 days (p < 0.05). Patients exhibiting POPF were treated conservatively and all patients were discharged in good health.

It may be concluded that: (1) drains should be withdrawn carefully according to the volume and characteristics of exudates; (2) mechanical staplers are promising devices for distal pancreatic resection; and (3) laparoscopic procedures are also promising for distal pancreatic resection.