title: A thick pancreas is a risk factor for pancreatic fistula after a distal pancreatectomy: selection of the closure technique according to the thickness.
abstract: OBJECTIVE
  Hand-sewn closures or stapler closures of the pancreatic remnant after a distal pancreatectomy have commonly been employed; however, the choice of technique in each patient depending on their clinical characteristics has not been discussed.
  
  
  METHODS
  Forty-eight patients who underwent a distal pancreatectomy at Osaka University Hospital between January 2007 and October 2009 were enrolled. A hand-sewn closure was planned during the 1st period (before June 2008, 26 consecutive patients), whereas a stapler closure was planned for the 2nd period (after June 2008, 22 consecutive patients). The incidence of pancreatic fistula and the patients' characteristics were retrospectively investigated.
  
  
  RESULTS
  Seven patients (27%) developed a fistula in the hand-sewn group, while 5 (23%) developed a fistula in the stapler group (p = n.s.). Using logistic regression analysis for all patients, younger age and the thickness of the pancreatic remnant were identified as independent risk factors for pancreatic fistula. In the stapler group, 50% of patients with a thick pancreas developed a pancreatic fistula, while no patients with a thin pancreas developed one.
  
  
  CONCLUSIONS
  Thick pancreas is one of the risk factors for pancreatic fistula after a distal pancreatectomy; however, a stapler closure seems to be suitable at least for thin pancreas.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Osaka University, Japan. heguchi@gesurg.med.osaka-u.ac.jp
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanemura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D013537:Sutures; D055815:Young Adult