title: Novel method of stump closure for distal pancreatectomy with a 75% reduction in pancreatic fistula rate.
abstract: BACKGROUND
  Pancreatic fistula is a significant problem for patients undergoing distal pancreatectomy with fistula rates up to 61%. Fistulas lead to substantial morbidity. The study objective was to compare radiofrequency dissector closure with traditional stump closure for distal pancreatectomy.
  
  
  METHODS
  Sixty-two patients underwent distal pancreatectomy at our institution between 2002 and 2011. Thirty-three patients had traditional stump closure compared with 29 patients who had radiofrequency closure. Fistula rates, operative times, and blood loss were compared. The control patients underwent open operation in 20 (60%) cases and laparoscopic operation in the remaining 13 (40%). Of the patients that underwent radiofrequency closure, 10 (35%) underwent open operation, and the remaining 19 (65%) patients underwent laparoscopic operation.
  
  
  RESULTS
  Fistula occurred in 12 of 33 (36%) patients with traditional stump closure compared to 3 of 29 (10%) patients with radiofrequency closure (p<0.02). Operative time (307 vs. 231 min [p<0.002]) and blood loss (364-200 mL [p<0.02]) were decreased in the radiofrequency closure group. Length of stay decreased from 7.8 to 6.6 days; however, this was not statistically significant.
  
  
  CONCLUSIONS
  The use of radiofrequency dissector in distal pancreatectomy is effective with low rates of fistula formation. Radiofrequency closure should be studied further in prospective trials.
authors.affiliation: Geisinger Medical Center, Section of Surgical Oncology, 100 N. Academy Avenue, MC 21-69, Danville, PA, USA. jblansfield1@geisinger.edu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Blansfield
authors.forename: Megan M
authors.initials: MM
authors.lastname: Rapp
authors.forename: Ravi J
authors.initials: RJ
authors.lastname: Chokshi
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Woll
authors.forename: Marie A
authors.initials: MA
authors.lastname: Hunsinger
authors.forename: David G
authors.initials: DG
authors.lastname: Sheldon
authors.forename: Mohsen M
authors.initials: MM
authors.lastname: Shabahang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology