Journal of Gastrointestinal Surgery

, Volume 11, Issue 3, pp 345–349

Staple Line Reinforcement Reduces Postoperative Pancreatic Stump Leak After Distal Pancreatectomy

  • Ramon E. Jimenez
  • Arun Mavanur
  • William P. Macaulay


Pancreatic stump leak is the major source of morbidity after stapled distal pancreatectomy. We hypothesized that reinforcement of the stapler system with a buttress mat can improve leak rates when compared to standard stapling alone. We performed 13 consecutive distal pancreatectomies using our reinforced stapler system, forming our experimental group. A historical control group was composed of 18 patients undergoing stapled pancreatic closure without reinforcement. The main outcome measure was pancreatic leak in the postoperative period. Pancreatic leaks included fistulas and fluid collections (sterile or infected). Hospital length of stay was recorded as a secondary measure. Postoperative pancreatic leak rate was zero in the experimental group, but 39% in the control group (P = 0.025). Development of a pancreatic leak resulted in prolonged hospital stays: 13.6 vs 8.3 days (P < 0.03). We conclude that staple line reinforcement is a simple and effective method of reducing pancreatic stump leakage after distal pancreatectomy. The economic impact of lower leak rates is reflected in significantly shorter hospital stays. The results of our study should be validated in a randomized controlled trial.


Pancreatectomy Stapler Fistula 


  1. 1.
    Bilimoria, M. M., Cormier, J. N., Mun, Y., Lee, J. E., Evans, D. B., & Pisters, P. W. (2003). Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. British Journal of Surgery, 90(2), 190–196.PubMedCrossRefGoogle Scholar
  2. 2.
    Pachter, H. L., Pennington, R., Chassin, J., & Spencer, F. C. (1979) Simplified distal pancreatectomy with the Auto Suture stapler: preliminary clinical observations. Surgery, 85(2), 166–170.PubMedGoogle Scholar
  3. 3.
    Connor, S., Alexakis, N., Garden, O. J., Leandros, E., Bramis, J., & Wigmore, S. J. (2005). Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. British Journal of Surgery, 92(9), 1059–1067.PubMedCrossRefGoogle Scholar
  4. 4.
    Suc, B., Msika, S., Fingerhut, A., Fourtanier, G., Hay, J. M., Holmieres, F., et al. (2003). Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Annals of Surgery, 237(1), 57–65.PubMedCrossRefGoogle Scholar
  5. 5.
    Suzuki, Y., Kuroda, Y., Morita, A., Fujino, Y., Tanioka, Y., Kawamura, T., et al. (1995). Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Archives of Surgery, 130(9), 952–955.PubMedGoogle Scholar
  6. 6.
    Abe, N., Sugiyama, M., Suzuki, Y., Yamaguchi, Y., Yanagida, O., Masaki, T., et al. (2006). Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. American Journal of Surgery, 191(2), 198–200.PubMedCrossRefGoogle Scholar
  7. 7.
    Knaebel, H. P., Diener, M. K., Wentem M. N., Buchler, M. W., & Seiler, C. M. (2005). Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. British Journal of Surgery, 92(5), 539–546.PubMedCrossRefGoogle Scholar
  8. 8.
    D’Angelica, M., Are, C., Jarnagin, W., DeGregoris, G., Coit, D., Jaques, D., et al. (2006). Initial experience with hand-assisted laparoscopic distal pancreatectomy. Surgical Endoscopy, 20(1), 142–148.PubMedCrossRefGoogle Scholar
  9. 9.
    Balcom, J. H., Rattner, D. W., Warshaw, A. L., Chang, Y., & Fernandez-del Castillo, C. (2001). Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Archives of Surgery, 136(4), 391–398.PubMedCrossRefGoogle Scholar
  10. 10.
    Buchler, M. W., Friess, H., Wagner, M., Kulli, C., Wagener, V., & Z’Graggen, K. (2000). Pancreatic fistula after pancreatic head resection. British Journal of Surgery, 87(7), 883–889.PubMedCrossRefGoogle Scholar
  11. 11.
    Kazanjian, K. K., Hines, O. J., Eibl, G., & Reber, H. A.(2005). Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. Archives of Surgery, 140(9), 849–854.PubMedCrossRefGoogle Scholar
  12. 12.
    Bassi, C., Falconi, M., Salvia, R., Mascetta, G., Molinari, E., & Pederzoli, P. (2001). Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Digestive Surgery, 18(6), 453–457.PubMedCrossRefGoogle Scholar
  13. 13.
    Lin, J. W., Cameron, J. L., Yeo, C. J., Riall, T. S., & Lillemoe, K. D. (2004). Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. Journal of Gastrointestinal Surgery, 8(8), 951–959.PubMedCrossRefGoogle Scholar
  14. 14.
    Arnold, W., & Shikora, S. A. (2005). A comparison of burst pressure between buttressed versus non-buttressed staple-lines in an animal model. Obesity Surgery, 15(2), 164–171.PubMedCrossRefGoogle Scholar
  15. 15.
    Downey, D. M., Michel, M., Harre, J. G., & Pratt, J. W. (2006). Functional assessment of a new staple line reinforcement in lung resection. Journal of Surgical Research, 131(1), 49–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ramon E. Jimenez
    • 1
    • 2
  • Arun Mavanur
    • 1
  • William P. Macaulay
    • 1
  1. 1.Department of Surgery, University of Connecticut Medical SchoolHartford HospitalHartfordUSA
  2. 2.Hartford HospitalHartfordUSA

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