The Rate of Postoperative Pancreatic Fistula after Distal Pancreatectomy Is Independent of The Surgical Technique of The Closure of The Pancreatic Remnant

Distal pancreatectomy is a common procedure for benigne and malignant neoplasmas of pancreatic body or tail and can be performed with or without splenectomy depending on the lesion. Advances in visceral surgery reduced the mortality after pancreas resection, but morbidity due to postoperative pancreatic fistula (POPF) remains essentially unchanged ranging from 16% to 44%. Many techniques have been developed to prevent pancreatic fistula after distal pancreatectomy, but even with all those techniques POPF rates remain high. The aim of our study was to evaluate POPF occurrence after closure of the pancreatic remnant by different operative techniques. Between 2004 and 2013 152 patients underwent distal pancreatectomy at the Clinic of General and Visceral Surgery, University of Freiburg. Type A, B, C fistulas were defined in accordance with ISGPF classification. Patients were divided in stapler closure and hand-sewn groups. The hand-sewn techniques were fishmouth-technique and two types of serosal patch using the 2nd jejunal loop. Hereby the fixation of the intestine to the pancreatic remnant was achieved by either interrupted U-suture or by common interrupted suture. All other techniques were summarized in a separate group. Perioperative data was collected in a SPSS database (SPSS, Version 22.0, SPSS Inc., Chicago, IL, USA). Statistical significance was tested using the Krusal-Wallis and Chi-square tests. Median age of patients was 61 (range 23 – 88) years. The age and gender were distributed similarly in all groups. 38 of 152 patients (25%) were operated by using a spleen preserving technique. The rate of splenectomy in all groups was similar. Most patients had an ASA 2 score and there was no significant difference in study groups. The rate of maligne diseases, chronic pancreatitis, alcohol and nicotine abuseand BMI were equally distributed in all groups. The rate of POPF in group of fishmouth-technique and interrupted U-suture was 34,5% and 36,8%, in the group of stapler closure and common interrupted suture 33.3% and 24.1% respectively. Comparison of different groups showed, that surgical technique of the closure of the pancreatic remnant after distal pancreatectomy has no influence on the postoperative pancreatic fistula rate. Fishmouth-technique Stapler closure InterruptedU-suture technique Common interrupted suture Others N 29 36 38 29 20 Pancreatic fistula (B or C), n, % 10 (34,5%) 12 (33,3%) 14 (36,8%) 7 (24,1%) 7 (35,0%)