Arguments for an individualized closure of the pancreatic remnant after distal pancreatic resection.
OBJECTIVE
To analyze risk factors for postoperative pancreatic fistula (POPF) rate after distal pancreatic resection (DPR).


METHODS
We performed a retrospective analysis of 126 DPRs during 16 years. The primary endpoint was clinically relevant pancreatic fistula.


RESULTS
Over the years, there was an increasing rate of operations in patients with a high-risk pancreas and a significant change in operative techniques. POPF was the most prominent factor for perioperative morbidity. Significant risk factors for pancreatic fistula were high body mass index (BMI) [odds ratio (OR) = 1.2 (CI: 1.1-1.3), P = 0.001], high-risk pancreatic pathology [OR = 3.0 (CI: 1.3-7.0), P = 0.011] and direct closure of the pancreas by hand suture [OR = 2.9 (CI: 1.2-6.7), P = 0.014]. Of these, BMI and hand suture closure were independent risk factors in multivariate analysis. While hand suture closure was a risk factor in the low-risk pancreas subgroup, high BMI further increased the fistula rate for a high-risk pancreas.


CONCLUSIONS
We propose a risk-adapted and indication-adapted choice of the closure method for the pancreatic remnant to reduce pancreatic fistula rate.
Ulrich Friedrich Wellner, Frank Makowiec, Olivia Sick, Ulrich Theodor Hopt, Tobias Keck, Department of General and Visceral Surgery, University of Freiburg, 79106 Freiburg, Germany.
Ulrich Friedrich
UF
Wellner
Frank
F
Makowiec
Olivia
O
Sick
Ulrich Theodor
UT
Hopt
Tobias
T
Keck