Modified Reinforced Staple Closure Technique Decreases Postoperative Pancreatic Fistula After Distal Pancreatectomy
Ryoichi Miyamoto1,2, Naoki Sano1, Michihiro Maeda1
11Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
Abstract:
Postoperative pancreatic fistula (POPF) is a serious complication that can occur following distal pancreatectomy (DP). Recent studies demonstrated that the use of reinforced staplers with bioabsorbable mesh significantly reduced the incidence of POPF, although the safety and efficacy of this approach remain controversial. Therefore, we originally developed a modified closure technique that combines the use of a reinforced stapler with bioabsorbable mesh with suture closure of the main pancreatic duct. The aim of this study was to determine whether our closure technique is predictive of POPF after DP. Fifty-nine consecutive patients who underwent DP were retrospectively enrolled. Based on the closure technique, we divided the cohort into a suture group (group A; n = 39) and a modified closure group (group B; n = 20). Using multivariate analysis, surgical closure techniques, including our method, and other well-known POPF risk factors were independently assessed. Multivariate logistic regression analysis identified no pathological fibrosis (odds ratio [OR], 5.41; p < 0.01), body mass index (> 25 kg/m2) (OR, 3.01; p = 0.02), and pancreatic stump closure technique (group A) (OR, 2.04; p = 0.01) as independent risk factors for POPF. The present study indicated that our modified closure technique is an additional useful technique to reduce POPF after DP.
Insights
A novel modified closure technique for distal pancreatectomy significantly reduces postoperative pancreatic fistula (POPF) rates. This method, combining reinforced staplers with mesh and duct suture, proved effective in preventing POPF.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Abdominal Surgery
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication after distal pancreatectomy (DP).
- Existing methods using reinforced staplers with bioabsorbable mesh show variable results, necessitating further investigation into improved techniques.
- Controversy exists regarding the safety and efficacy of current POPF prevention strategies.
Purpose of the Study:
- To evaluate a newly developed modified closure technique for DP.
- To determine if this technique is predictive of POPF development.
- To compare the outcomes of the modified technique against standard suture closure.
Main Methods:
- Retrospective analysis of 59 patients undergoing DP.
- Patients were divided into two groups: standard suture closure (Group A) and modified closure (Group B).
- Multivariate logistic regression analysis assessed risk factors, including closure technique, pathological fibrosis, and BMI.
Main Results:
- The modified closure technique was associated with a reduced incidence of POPF.
- Independent risk factors for POPF included no pathological fibrosis (OR, 5.41), BMI > 25 kg/m² (OR, 3.01), and standard suture closure (Group A) (OR, 2.04).
- The modified technique demonstrated a protective effect against POPF.
Conclusions:
- The modified closure technique combining reinforced staplers with mesh and suture closure of the pancreatic duct is effective in reducing POPF after DP.
- This technique represents a valuable addition to surgical strategies for preventing POPF.
- Identifying and managing risk factors like fibrosis and BMI is crucial for POPF prevention.
