title: Closure of the pancreas in distal pancreatectomy: comparison between bare stapler and reinforced stapler.
abstract: OBJECTIVE
  Pancreatic fistula (PF) is a major complication after distal pancreatectomy (DP). Popularization of laparoscopic surgery for DP has promoted the use of stapler for transection and closing of the pancreas.
  
  
  METHODS
  We reviewed the medical records of 50 consecutive patients who underwent DP with stapler. Patients were divided into 2 groups: bare stapler (n=36) and reinforced stapler (n=14). We assessed the incidence of postoperative PF, systemic inflammatory response syndrome (SIRS), and intra-abdominal fluid collection on postoperative day 7.
  
  
  RESULTS
  The numbers of patients who developed grade A, grade B, and grade C PF were 17 (34%), 6 (12%), and 0, respectively. The incidence of postoperative PF was significantly lower in the reinforced stapler group (p=0.017). None of the patients in the reinforced stapler group developed grade B PF. Patients in the bare stapler group showed significantly higher incidence of postoperative SIRS (p=0.046), more extensive fluid collection (p=0.020), and longer postoperative hospital stay (p=0.023).
  
  
  CONCLUSIONS
  Decreased leakage of postoperative pancreatic juice into the abdominal cavity associated with the usage of the reinforced stapler may lead to reduced inflammatory reaction, low incidence of PF, and early hospital discharge.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurahara
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iino
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Hiwatashi
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000295:instrumentation*; D010185:Pancreatic Fistula / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013528:Surgical Staplers; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology