Pancreatic stump closure using only stapler is associated with high postoperative fistula rate after minimal invasive surgery

Özet

Background/Aims: Postoperative pancreatic fistula (POPF) is the most common cause of morbidity and mortality after distal pancre-atectomy (DP). The aim of the present study is to determine the risk factors that can lead to POPF.Materials and Methods: The study was conducted between January 2008 and December 2012. A total of 96 patients who underwent DP were retrospectively analyzed.Results: Overall, 24 patients (25%) underwent laparoscopic distal pancreatectomy (LDP) and 72 patients (75%) open surgery. The over-all morbidity rate was 51% (49/96). POPF (32/96, 33.3%) was the most common postoperative complication. Grade B fistula (18/32, 56.2%) was the most common fistula type according to the International Study Group on Pancreatic Fistula definition. POPF rate was significantly higher in the minimally invasive surgery group (50%, p=0.046). POPF rate was 58.6% (17/29) in patients whose pancre-atic stump closure was performed with only stapler, whereas POPF rate was 3.6% (1/28) in the group where the stump was closed with stapler plus oversewing sutures. Both minimally invasive surgery (OR: 0.286, 95% CI: 0.106-0.776, p=0.014) and intraoperative blood transfusion (OR: 4.210, 95% CI: 1.155-15.354, p=0.029) were detected as independent risk factors for POPF in multi-variety analysis.Conclusion: LDP is associated with a higher risk of POPF when stump closure is performed with only staplers. Intraoperative blood trans-fusion is another risk factor for POPF. On the other hand, oversewing sutures to the stapler line reduces the risk of POPF.