title: Does Pancreatic Stump Closure Method Influence Distal Pancreatectomy Outcomes?
abstract: BACKGROUND
  Pancreatic fistula remains the primary source of morbidity following distal pancreatectomy. Previous studies have reported specific methods of parenchymal transection/stump sealing in an effort to decrease the pancreatic fistula rate with highly variable results. The aim of this study was to determine postoperative outcomes following various pancreatic stump-sealing methods.
  
  
  METHODS
  All cases of distal pancreatectomy were reviewed at a single institution between January 2008 and June 2011 and were monitored with complete 30-day outcomes through ACS-NSQIP. Pancreatic stump-sealing method was used to create three operation groups (suture, staple, or saline-linked radiofrequency). Two- and three-way statistical analyses were performed among the operation groups.
  
  
  RESULTS
  Two hundred three patients underwent distal pancreatectomy. The most common diagnoses included chronic pancreatitis, adenocarcinoma, and IPMN. The suture, staple, and SLRF groups included 90 (44%), 61 (30%), and 52 (26%) patients, respectively. Overall complications (range 31-38%) and pancreatic fistula (range 25-26%) were similar with each pancreatic closure technique. Operative technique was not associated with an increased need for postoperative interventions or hospital readmission.
  
  
  CONCLUSIONS
  Postoperative outcomes after distal pancreatectomy are unaffected by the use of SLRF sealing of the pancreatic stump when compared to traditional suture or reinforced stapling techniques.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 541, Indianapolis, IN, 46202, USA, eceppa@iupui.edu.
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.forename: Robert M
authors.initials: RM
authors.lastname: McCurdy
authors.forename: David C
authors.initials: DC
authors.lastname: Becerra
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery; D010359:Patient Readmission; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects*