Open distal pancreatectomy stump closure by linear stapling versus continuous suturing: a retrospective–prospective comparative study

Background
Distal pancreatectomy (DP), performed for removing pancreatic lesions located to the left of the superior mesenteric vein, accounts for ~25% of all pancreatic resections. Most recently reported overall mortality rate of DP is less than 3%. However, albeit technically simpler to perform than pancreaticoduodenectomy, morbidity rate of DP remains substantial. Postoperative pancreatic fistulas (POPFs), which may result in numerous clinically significant and potentially life-threatening complications such as intraabdominal abscess, hemorrhage, and surgical site infection, is the leading cause of morbidity after DP, with an incidence of ~30–60%. Risk factors associated with POPFs after DP include decreased serum albumin levels, concurrent splenectomy, increased body weight, increased duration of surgery, higher American Society of Anesthesiologists score, and impaired renal function. Furthermore, POPFs often translate to significant increases in hospitalization costs.
Objective
To compare the technique of DP stump closure in two groups of patients; a group underwent stump closure with linear stapling technique and the other group underwent stump closure with continuous suturing technique.
Patients and methods
This was a retrospective–prospective clinical trial that was conducted at General Surgery Department, Ain Shams University Hospitals on 30 patients who were admitted to specialized hepatobiliary units in Cairo, Egypt for open DP. Between January 2020 and June 2022 with postoperative follow-up period of 2 months. In our study, there were 30 patients (15 in the continuous suturing technique group and 15 in the linear stapling technique group) with a mean age of 45.37±10.662 years. Groups were similar in demographic and clinical characteristics (>0.05).
Results
In our study, 13.33% patients in continuous suturing technique group developed clinically relevant POPF (grade B and grade C POPF), whereas 33.33% patients in stapling technique group develop POPF (=1.00). The amount of the blood loss which was found to be statistically significant as the value was found less than 0.05 and the test was found to be −2.396 which mean that the amount of the blood lost was more in the stapler group. There was no statistically significant difference in the rate of clinically relevant POPF (grade B and grade C POPF) with suture closure compared with stapler closure (13.33 vs. 33.33%). There was no statistically significant difference in the risk of intraabdominal abscess. There were three (20%) patients with a biochemical leak in continuous suturing technique group. In stapling technique group, three (20%) patients developed biochemical leaks. There was no significant in difference between groups in terms of biochemical leak. In our study, mortality rates did not differ between stapler and suture closure techniques.
Conclusion
Our study showed no significant difference between suture and stapler closure of DP stump with respect to POPF or intraabdominal collection after DP. The amount of the blood lost was more in the stapler group.