SSAT - Does Pancreatic Stump Closure Method Influence Fistula Rate After Distal Pancreatectomy

Does Pancreatic Stump Closure Method Influence Fistula Rate After Distal Pancreatectomy
Eugene P. Ceppa^*, Robert M. Mccurdy, Molly Kilbane, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski, Keith D. Lillemoe, Henry a. Pitt, Michael G. House
Surgery, Indiana University Medical Center, Indianapolis, IN

Introduction: Pancreatic fistula (PF) remains the primary morbidity following distal pancreatectomy (DP). Previous studies have reported specific methods of parenchymal transection and sealing in an effort to decrease the PF rate with highly variable results. The aim of this study was to determine the pancreatic fistula rate following various sealing methods.

Methods: All cases of DP were reviewed at a single high-volume institution between January 2008 and June 2011. Sealing method of the pancreatic stump was used to create operation groups (suture, staple, or saline linked radiofrequency (SLRF)). All cases were monitored with complete 30-day outcomes through the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Two and three-way statistical analyses were performed among the operation groups.

SLRF, N=52 Staple, N=61 Suture, N=90 p-value*
Overall complications 16 (31%) 23 (38%) 35 (39%) 0.61
Pancreatic fistula 13 (25%) 16 (26%) 23 (26%) 0.95
Panc fistula grade B/C 6 (11%) 11 (18%) 15 (17%) 0.60
Home drain 4 (8%) 10 (16%) 15 (17%) 0 0.29
IR drainage procedure 6 (11%) 6 (10%) 13 (14%) 0.71
30d hosp readmission 7 (14%) 14 (23%) 17 (19%) 0.44

*Chi-square correlations among all three groups

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