title: Teres Ligament Patch Reduces Relevant Morbidity After Distal Pancreatectomy (the DISCOVER Randomized Controlled Trial).
abstract: OBJECTIVE
  The aim of this study was to analyze the impact of teres ligament covering on pancreatic fistula rate after distal pancreatectomy (DP).
  
  
  BACKGROUND
  Postoperative pancreatic fistula (POPF) represents the most significant complication after DP. Retrospective studies suggested a benefit of covering the resection margin by a teres ligament patch.
  
  
  METHODS
  This prospective randomized controlled study (DISCOVER trial) included 152 patients undergoing DP, between October 2010 and July 2014. Patients were randomized to undergo closure of the pancreatic cut margin without (control, n = 76) or with teres ligament coverage (teres, n = 76). The primary endpoint was the rate of POPF, and the secondary endpoints included postoperative morbidity and mortality, length of hospital stay, and readmission rate.
  
  
  RESULTS
  Both groups were comparable regarding epidemiology (age, sex, body mass index), operative parameters (operation time [OP] time, blood loss, method of pancreas transection, additional operative procedures), and histopathological findings. Overall inhospital mortality was 0.6% (1/152 patients). In the group of patients with teres ligament patch, the rate of reoperations (1.3% vs 13.0%; P = 0.009), and also the rate of readmission (13.1 vs 31.5%; P = 0.011) were significantly lower. Clinically relevant POPF rate (grade B/C) was 32.9% (control) versus 22.4% (teres, P = 0.20). Multivariable analysis showed teres ligament coverage to be a protective factor for clinically relevant POPF (P = 0.0146).
  
  
  CONCLUSIONS
  Coverage of the pancreatic remnant after DP is associated with less reinterventions, reoperations, and need for readmission. Although the overall fistula rate is not reduced by the coverage procedure, it should be considered as a valid measure for complication prevention due to its clinical benefit.
authors.affiliation: *Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany†Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany‡Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hassenpflug
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Johanna
authors.initials: J
authors.lastname: Volpert
authors.forename: Philip
authors.initials: P
authors.lastname: Knebel
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
authors.forename: Colette
authors.initials: C
authors.lastname: Doerr-Harim
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008022:Ligaments / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000401:mortality / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome