Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis.
BACKGROUND
Suture closure and stapler closure of the pancreatic remnant after distal pancreatectomy are the techniques used most often. The ideal choice remains a matter of debate.


METHODS
Five bibliographic databases covering 1970 to July 2009 were searched.


RESULTS
Sixteen articles met the inclusion criteria. Stapler closure was performed in 671 patients, while suture closure was conducted in 1,615 patients. The pancreatic fistula rate ranged from 0% to 40.0% for stapler closure of the pancreatic stump and from 9.3% to 45.7% for the suture closure technique. There were no significant difference between the stapler and suture closure groups with respect to the pancreatic fistula formation rate (22.1% vs 31.2%; odds ratio, .85; 95% confidence interval, .66-1.08), although there was a trend toward favoring stapler closure. In 4 studies including 437 patients, stapler closure was associated with a trend (not statistically significant) toward a reduction in intra-abdominal abscess (odds ratio, .53; 95% confidence interval, .24-1.15).


CONCLUSIONS
No significant differences occur between suture and stapler closure with respect to the pancreatic fistula or intra-abdominal abscess after distal pancreatectomy, though there is a trend favoring stapler closure.
Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Wei
W
Zhou
Ran
R
Lv
Xianfa
X
Wang
Yiping
Y
Mou
Xiujun
X
Cai
Ingrid
I
Herr
D004867:Equipment Design; D006801:Humans; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures