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Updated: Jun 19, 2025
Application of End-to-end Anastomosis in Robotic Central Pancreatectomy
Published on: June 2, 2018
Efficacy of Reinforced Stapler for Preventing Postoperative Pancreatic Fistula After Minimally Invasive Distal
Tomoki Ryu1, Yoriko Nomura2, Kazuki Takeishi2
1Department of Hepato-Biliary-Pancreatic Surgery, NHO Kyushu Medical Center, Fukuoka, Japan ryu.tomoki.mq@mail.hosp.go.jp.
Background/Aim:
Although minimally invasive distal pancreatectomy (MIDP) has become a treatment option for benign and malignant pancreatic tumors, the safety and efficacy of reinforced staplers in MIDP remain controversial. The present study was performed to evaluate the safety of reinforced staplers in MIDP and identify the risk factors for postoperative pancreatic fistula (POPF) after MIDP with reinforced staplers.
Patients And Methods:
In total, 92 consecutive patients who underwent MIDP at NHO Kyushu Medical Center from July 2016 to August 2023 were enrolled in this retrospective study. In all patients, a reinforced black cartridge triple-row stapler (Covidien Japan, Tokyo, Japan) was used during MIDP. The primary endpoint was the incidence of clinically relevant POPF. The risk factors for POPF were evaluated using multivariate analysis.
Results:
Among the 92 patients, 74 underwent laparoscopic distal pancreatectomy and 18 underwent robot-assisted distal pancreatectomy. Clinically relevant POPF occurred in seven (7.6%) of 92 patients. The rate of severe complications (Clavien-Dindo grade ≥III) was 10.8%, and the mortality rate was 0%. The median postoperative hospital stay was 14 days. Multivariate logistic regression analysis showed that the independent risk factor for clinically relevant POPF after MIDP with a reinforced stapler was a body mass index of ≥22.6 kg/m2 (p=0.050, odds ratio=7.60).
Conclusion:
This study confirmed the safety and efficacy of reinforced staplers for preventing POPF after MIDP. A high body mass index was the only risk factor for clinically relevant POPF after MIDP with a reinforced stapler.
Insights
Reinforced staplers are safe for minimally invasive distal pancreatectomy (MIDP). High body mass index (BMI) is the main risk factor for postoperative pancreatic fistula (POPF) after MIDP using these staplers.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Minimally invasive distal pancreatectomy (MIDP) is an option for pancreatic tumors.
- The safety of reinforced staplers in MIDP for preventing postoperative pancreatic fistula (POPF) is debated.
Purpose of the Study:
- Evaluate the safety and efficacy of reinforced staplers in MIDP.
- Identify risk factors for POPF after MIDP using reinforced staplers.
Main Methods:
- Retrospective study of 92 patients undergoing MIDP with reinforced staplers.
- Primary endpoint: incidence of clinically relevant POPF.
- Multivariate analysis to identify POPF risk factors.
Main Results:
- Clinically relevant POPF occurred in 7.6% of patients.
- Severe complications (Clavien-Dindo grade ≥III) were 10.8%; mortality was 0%.
- High body mass index (BMI) ≥22.6 kg/m² was the sole independent risk factor for POPF (OR=7.60, p=0.050).
Conclusions:
- Reinforced staplers are safe and effective for preventing POPF in MIDP.
- Elevated BMI is the primary risk factor for POPF in this procedure.
