title: Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates.
abstract: BACKGROUND
  Pancreatic fistula is a major source of morbidity after distal pancreatectomy (DP). We reviewed 462 consecutive patients undergoing DP to determine if the method of stump closure impacted fistula rates.
  
  
  METHODS
  A retrospective review of clinicopathologic variables of patients who underwent DP between February 1994 and February 2008 was performed. The International Study Group classification for pancreatic fistula was utilized (Bassi et al., Surgery, 138(1):8-13, 2005).
  
  
  RESULTS
  The overall pancreatic fistula rate was 29% (133/462). DP with splenectomy was performed in 321 (69%) patients. Additional organs were resected in 116 (25%) patients. The pancreatic stump was closed with a fish-mouth suture closure in 227, of whom 67 (30%) developed a fistula. Pancreatic duct ligation did not decrease the fistula rate (29% vs. 30%). A free falciform patch was used in 108 patients, with a fistula rate of 28% (30/108). Stapled compared to stapled with staple line reinforcement had a fistula rate of 24% (10/41) vs. 33% (15/45). There is no significant difference in the rate of fistula formation between the different stump closures (p = 0.73). On multivariate analysis, BMI > 30 kg/m(2), male gender, and an additional procedure were significant predictors of pancreatic fistula.
  
  
  CONCLUSIONS
  The pancreatic fistula rate was 29%. Staplers with or without staple line reinforcement do not significantly reduce fistula rates after DP. Reduction of pancreatic fistulas after DP remains an unsolved challenge.
authors.affiliation: Department of General Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. cferrone@partners.org
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.forename: Ruben
authors.initials: R
authors.lastname: Rodriguez
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-del Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques; D055815:Young Adult