title: Randomized clinical trial of duct-to-mucosa pancreaticogastrostomy versus handsewn closure after distal pancreatectomy.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) remains a major cause of morbidity after distal pancreatectomy. The aim of this study was to investigate whether duct-to-mucosa pancreaticogastrostomy of the pancreatic stump decreased clinical POPF formation compared with handsewn closure after distal pancreatectomy.
  
  
  METHODS
  This multicentre RCT was performed between April 2012 and June 2014. Patients undergoing distal pancreatectomy were assigned randomly to either duct-to-mucosa pancreaticogastrostomy or handsewn closure. The primary endpoint was the incidence of clinical POPF. Secondary endpoints were rates of other complications and length of hospital stay.
  
  
  RESULTS
  Some 80 patients were randomized, and 73 patients were evaluated in an intention-to-treat analysis: 36 in the pancreaticogastrostomy group and 37 in the handsewn closure group. The duration of operation was significantly longer in the pancreaticogastrostomy group than in the handsewn closure group (mean 268 versus 197 min respectively; P < 0·001). The incidence of clinical POPF did not differ between groups (7 of 36 versus 7 of 37; odds ratio (OR) 1·03, 95 per cent c.i. 0·32 to 3·10; P = 1·000). The rate of intra-abdominal fluid collection was significantly lower in the pancreaticogastrostomy group (6 of 36 versus 21 of 37; OR 0·15, 0·05 to 0·45; P < 0·001). There were no statistically significant differences in the rates of other complications or length of hospital stay.
  
  
  CONCLUSIONS
  Duct-to-mucosa pancreaticogastrostomy did not reduce the incidence of clinical POPF compared with handsewn closure of the pancreatic stump after distal pancreatectomy. Registration number UMIN000007426 (http://www.umin.ac.jp).
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Uemura
authors.affiliation: Department of Surgery, Kansai Medical University, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Satoi
authors.affiliation: Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Motoi
authors.affiliation: Department of Surgery, Kansai Medical University, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Unno
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Murakami
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013536:Suture Techniques