title: Risk factors for pancreatic fistula after stapled gland transection.
abstract: The objective of this study was to identify risk factors for pancreatic fistula (PF) after stapled transection in distal pancreatectomy (DP). Patients undergoing DP using a stapler for transection between 2005 and 2009 were identified from a pancreatic resection database. Variables  examined included patient and tumor characteristics, staple size, and the use of mesh reinforcement. Univariate and multivariate regression analyses were performed to identify risk factors for postoperative PF. One hundred forty-nine had stapled transection, and of these, 25 (17%) had mesh  reinforcement. The overall morbidity and mortality rates were 28 per cent and less than 1 per cent; 34 (23%) were diabetic. The rate of clinically significant PF was 14 per cent. On univariate analysis, diabetes (P = 0.04), a firm pancreas (P = 0.03), use of mesh staple line  reinforcement (P = 0.02), use of a 4.1-mm staple cartridge (P = 0.01), and blood loss greater than 100 mL (P = 0.01) were associated with higher pancreatic fistula rates. On multivariate analysis, only the presence of diabetes (OR, 4.17; 95% CI, 1.1-15.3; P  = 0.03) and the use of a 4.1-mm cartridge (OR, 8.57; 95% CI, 1.2-60.2; P = 0.03) were independently associated with pancreatic fistula formation. Stapled pancreatic transection provides an acceptable PF rate after DP. Diabetes and staple size influence PF rates. In our experience,  use of mesh staple line reinforcement did not reduce the incidence of PF after stapled transection.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA. preets1013@gmail.com
authors.forename: Preeti D
authors.initials: PD
authors.lastname: Subhedar
authors.forename: Sameer H
authors.initials: SH
authors.lastname: Patel
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kneuertz
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: John R
authors.initials: JR
authors.lastname: Galloway
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D017792:Surgical Stapling / Q000009:adverse effects* / Q000295:instrumentation; D013718:Tensile Strength; D016896:Treatment Outcome; D055815:Young Adult