This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Systematic review and meta‐analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. BJS 2015; 102: 4-15.

Published: 12th November 2014

Authors: H. Zhang, F. Zhu, M. Shen, R. Tian, C. J. Shi, X. Wang et al.

Background

Established closure techniques for the pancreatic remnant after distal pancreatectomy include stapler, suture and anastomotic closure. However, controversy remains regarding the ideal technique; therefore, the aim of this study was to compare closure techniques and risk of postoperative pancreatic fistula (POPF).

Method

A systematic review was carried out according to PRISMA guidelines for studies published before January 2014 that compared at least two closure techniques for the pancreatic remnant in distal pancreatectomy. A random‐effects model was constructed using weighted odds ratios (ORs).

Results

Thirty‐seven eligible studies matched the inclusion criteria and 5252 patients who underwent distal pancreatectomy were included. The primary outcome measure, the POPF rate, ranged 0 from to 70 per cent. Meta‐analysis of the 31 studies comparing stapler versus suture closure showed that the stapler technique had a significantly lower rate of POPF, with a combined OR of 0·77 (95 per cent c.i. 0·61 to 0·98; P = 0·031). Anastomotic closure was associated with a significantly lower POPF rate than suture closure (OR 0·55, 0·31 to 0·98; P = 0·042). Combined stapler and suture closure had significantly lower POPF rates than suture closure alone, but no significant difference compared with stapler closure alone.

Conclusion

The use of stapler closure or anastomotic closure for the pancreatic remnant after distal pancreatectomy significantly reduces POPF rates compared with suture closure. The combination of stapler and suture closure shows superiority over suture closure alone.

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