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Related Experiment Video

Updated: Jun 26, 2026

Application of Simplified Stent-bridging Pancreaticogastrostomy in Open Pancreaticoduodenectomy
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Published on: March 17, 2026

A Multicenter, Single-Blind, Randomized Trial Comparing Stapler Closure With Clip-on-Staple Method Versus Stapler

Mizuki Ninomiya1,2, Ken Shirabe3, Kengo Fukuzawa4

  • 1From the Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan.

Annals of Surgery Open : Perspectives of Surgical History, Education, and Clinical Approaches
|June 25, 2026
PubMed

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Summary

The clip-on-staple method significantly reduces clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP), especially in patients with thicker pancreatic tissue. This technique offers a promising approach to improve patient outcomes following DP.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Clinical Trials

Background:

  • Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication following distal pancreatectomy (DP).
  • Patients with thick pancreatic parenchyma are at higher risk for CR-POPF.
  • There is a need for effective strategies to mitigate CR-POPF after DP.

Purpose of the Study:

  • To evaluate the efficacy of the clip-on-staple method in reducing CR-POPF after DP.
  • To compare the clip-on-staple method against reinforced stapler closure alone.

Main Methods:

  • A multicenter, single-blind, randomized controlled trial (CLIP-DP) involving 16 Japanese institutions.
  • Adult patients undergoing DP were randomized to either stapler closure alone or the clip-on-staple method.
Keywords:
distal pancreatectomypostoperative complicationpostoperative pancreatic fistula

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Last Updated: Jun 26, 2026

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  • The primary endpoint was CR-POPF (grade B/C) or death within 30 days, analyzed in both full-analysis and per-protocol sets.

    • Main Results:

    • The clip-on-staple method showed a trend towards reduced CR-POPF or death in the full-analysis set (15.2% vs 23.5%, P=0.184).
    • In the per-protocol set, the clip-on-staple method significantly reduced CR-POPF or death (12.5% vs 24.4%, P=0.049).
    • A pronounced reduction in CR-POPF was observed in patients with pancreatic thickness >12 mm in both analysis sets (P=0.032 and P=0.004).

    Conclusions:

    • The clip-on-staple method is effective in reducing CR-POPF after distal pancreatectomy.
    • The greatest benefit of the clip-on-staple method is observed in patients with thick pancreatic parenchyma.
    • This technique represents a valuable advancement in minimizing postoperative complications following DP.