Closure of the Pancreas in Distal Pancreatectomy: Comparison between Bare Stapler and Reinforced Stapler

Background/Aims: 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. Methodology: 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 PP were 17 (34%), 6 (12%), and 0, respectively. The incidence of postoperative PP was significantly lower in the reinforced stapler group (p=0.017). None of the patients in the reinforced stapler group developed grade B PP. 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 PP, and early hospital discharge.