Pancreatic Fistula after Distal Pancreatectomy with Stapler
Wen Yao Yin1,2, Chun Ming Chang3,2, Guo-Fang Tseng2,4
1Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan. (Dr. Yin).
Objective:
To identify a distal pancreatectomy (DP) surgical procedure with a low risk for fistula.
Summary Background Data:
Common use of computed tomography (CT) increases detection of pancreatic lesions early or incidentally.
Methods:
We retrospectively analyzed data from 63 patients with DP between 2000 and 2021. Fifty-three patients were diagnosed with tumors and 10 without. The pancreatic thickness at the resection site was measured on CT before surgery. We compared the postoperative outcomes of patients with and without postoperative pancreatic fistula (POPF).
Results:
Twenty-six patients (41%) were male, and the mean age was 54 ± 15 years. Patients with severe POPF had poorer outcomes, including severe complications, readmission, resurgery, and longer hospital stays than did those without (P ≤ .05). The pancreas thickness cutoff for discriminating severe pancreatic fistula was 13.2 mm, with an area under the curve of 71.4% (95% confidence interval [CI], 56.0-86.7%). Multivariable analysis showed that a thickness >13.2 mm (odds ratio [OR], 11.11; 95% CI, 1.92-64.12), more recent surgery (OR, 5.86; 95% CI, 1.29-26.51), and use of suture only (OR, 5; 95% CI, 1.12-20) were significantly associated with severe POPF.
Conclusions:
DP has a high leakage rate, with some morbidity and mortality. DP thickness >13.2 mm was associated with a higher risk of POPF. Gastrointestinal anastomosis stapling, especially using the double clamping technique, is safe and results in less POPF, as shown in both clinical and cadaveric studies.
