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01-10-2008 | ssat plenary presentation

Pancreatic Fistula Rates After 462 Distal Pancreatectomies: Staplers Do Not Decrease Fistula Rates

Authors: Cristina R. Ferrone, Andrew L. Warshaw, David W. Rattner, David Berger, Hui Zheng, Bhupendra Rawal, Ruben Rodriguez, Sarah P. Thayer, Carlos Fernandez-del Castillo

Published in: Journal of Gastrointestinal Surgery | Issue 10/2008

Abstract

Introduction

Pancreatic fistula is a major source of morbidity after distal pancreatectomy (DP). We reviewed 462 consecutive patients undergoing DP to determine if the method of stump closure impacted fistula rates.

Methods

A retrospective review of clinicopatologic variables of patients who underwent DP between February 1994 and February 2008 was performed. The International Study Group classification for pancreatic fistula was utilized (Bassi et al., Surgery, 138(1):8–13, 2005).

Results

The overall pancreatic fistula rate was 29% (133/462). DP with splenectomy was performed in 321 (69%) patients. Additional organs were resected in 116 (25%) patients. The pancreatic stump was closed with a fish-mouth suture closure in 227, of whom 67 (30%) developed a fistula. Pancreatic duct ligation did not decrease the fistula rate (29% vs. 30%). A free falciform patch was used in 108 patients, with a fistula rate of 28% (30/108). Stapled compared to stapled with staple line reinforcement had a fistula rate of 24% (10/41) vs. 33% (15/45). There is no significant difference in the rate of fistula formation between the different stump closures (p = 0.73). On multivariate analysis, BMI > 30 kg/m², male gender, and an additional procedure were significant predictors of pancreatic fistula.

Conclusions

The pancreatic fistula rate was 29%. Staplers with or without staple line reinforcement do not significantly reduce fistula rates after DP. Reduction of pancreatic fistulas after DP remains an unsolved challenge.

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Title: Pancreatic Fistula Rates After 462 Distal Pancreatectomies: Staplers Do Not Decrease Fistula Rates
Authors: Cristina R. Ferrone
Andrew L. Warshaw
David W. Rattner
David Berger
Hui Zheng
Bhupendra Rawal
Ruben Rodriguez
Sarah P. Thayer
Carlos Fernandez-del Castillo
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0636-2

At a glance: The STEP trials

Springer Medicine

Pancreatic Fistula Rates After 462 Distal Pancreatectomies: Staplers Do Not Decrease Fistula Rates

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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