title: Further experience with pancreatic stump closure using a reinforced staple line.
abstract: BACKGROUND
  We previously demonstrated that pancreatic transection with a reinforced staple line results in significantly lower fistula rates than when stapling without reinforcement. (J Gastrointest Surg. 2007;11:345-349). Criticism of this initial study focused on the small size of the treated group (N = 13). We report four more years of experience with this technique with a larger sample size.
  
  
  METHODS
  This was a before-after trial. Patients included had distal pancreatectomies with stapled stump closure. The main intervention analyzed was staple-line reinforcement with Seamguard. The experimental group consisted of a consecutive series of stapled pancreatectomies with reinforcement performed from 2005 to 2010. The control group was a consecutive series of stapled pancreatectomies without reinforcement performed between 2003 and 2005 (previously published). The main outcome measure was pancreatic fistula.
  
  
  RESULTS
  54 patients were included; 36 in the experimental group and 18 in the control group. Mean age was 62; 50% were males. The most common diagnoses were adenocarcinoma (31%), cystic neoplasm (24%), and neuroendocrine tumor (22%). There were no mortalities. Postoperative pancreatic leak rate was 39% in the control group, and 8% in the experimental group (P = 0.01). Seven of ten patients with leak required additional drain placement. Development of pancreatic leak resulted in prolonged hospital stays (12 vs eight days, P < 0.007).
  
  
  CONCLUSIONS
  We demonstrate sustained success of reinforced stapling for pancreatic stump closure. Our technique is straightforward and results in reduced morbidity and cost. Our results suggest that surgical drains may not be needed when this technique is applied.
authors.affiliation: Medical College of Georgia, Augusta, GA, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wallace
authors.forename: Georgios V
authors.initials: GV
authors.lastname: Georgakis
authors.forename: David P
authors.initials: DP
authors.lastname: Eisenberg
authors.forename: William P
authors.initials: WP
authors.lastname: Macaulay
authors.forename: Ramon E
authors.initials: RE
authors.lastname: Jimenez
mesh_terms: D020341:Absorbable Implants; D000230:Adenocarcinoma / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000601:surgery; D018358:Neuroendocrine Tumors / Q000601:surgery; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome