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To Suture or Staple the Pancreatic Stump

To Suture or Staple the Pancreatic Stump. 8/10/2007 Mentor: Dr Haghighi. Background. Distal pancreatectomy Defined as resection to the left of the superior mesenteric vein. Mortality rate is 0-6% Leakage from the stump is the main cause of morbidity.

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To Suture or Staple the Pancreatic Stump

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  1. To Suture or Staple the Pancreatic Stump 8/10/2007 Mentor: Dr Haghighi

  2. Background • Distal pancreatectomy • Defined as resection to the left of the superior mesenteric vein. • Mortality rate is 0-6% • Leakage from the stump is the main cause of morbidity. • Numerous ways to close eg. Suture, staple, glue, mesh, ultrasonic dissection, prolamine injections

  3. Background • Indications • adenocarcinoma • Cystadenoma • Neuroendocrine tumours • Chronic pancreatitis • trauma • Gastric Ca

  4. Background • Numerous papers, including RCT, on stapler vs suture topic. • “Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy”. BJS 2005. Heidelberg Germany.

  5. Method • Literature search with key words: “pancreas, pancreatectomy, left resection, distal pancreatectomy, fistula, complication rate”. • Inclusion: RCTs and observational studies with a technical description of at least one surgical procedure and one control group • Exclusions: Technical aspects not covered

  6. Method

  7. Results

  8. Results • Ten articles overall, 2 RCT • 1080 patients • Variable leak rate: 0 – 61% • Staple leak rate average: 22.9% • Suture leak rate average: 34.9% • Meta-analysis slightly favours staple closure, p=0.21.

  9. Conclusion • “The meta-analysis indicated a statistically non-significant, but possibly clinically relevant, trend towards superiority of stapler closure.” • RCT must be conducted to verify this.

  10. Critique • Strengths • Meta-analysis • Overall Large patient group • Reviewed numerous papers • Weakness • Heterogeneity: patients, surgeons, staples, sutures • Different definitions of leak/fistula • Many studies had small group size • Used only 2 RCT’s • Authors data collection

  11. What about using both? • “Staple Line Reinforcement Reduces Postoperative Pancreatic Stump Leak After Distal Pancreatectomy” : J Gastrointest Surg (2007) 11:345–349 • 0% Leak rate using mattress suture reinforcement of staple line (13 patients)

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