Modified Reinforced Staple Closure Technique Decreases Postoperative Pancreatic Fistula After Distal Pancreatectomy

  • Ryoichi MiyamotoEmail author
  • Naoki Sano
  • Michihiro Maeda
  • Satoshi Inagawa
  • Nobuhiro Ohkohchi
Original Article


Postoperative pancreatic fistula (POPF) is a serious complication that can occur following distal pancreatectomy (DP). Recent studies demonstrated that the use of reinforced staplers with bioabsorbable mesh significantly reduced the incidence of POPF, although the safety and efficacy of this approach remain controversial. Therefore, we originally developed a modified closure technique that combines the use of a reinforced stapler with bioabsorbable mesh with suture closure of the main pancreatic duct. The aim of this study was to determine whether our closure technique is predictive of POPF after DP. Fifty-nine consecutive patients who underwent DP were retrospectively enrolled. Based on the closure technique, we divided the cohort into a suture group (group A; n = 39) and a modified closure group (group B; n = 20). Using multivariate analysis, surgical closure techniques, including our method, and other well-known POPF risk factors were independently assessed. Multivariate logistic regression analysis identified no pathological fibrosis (odds ratio [OR], 5.41; p < 0.01), body mass index (> 25 kg/m2) (OR, 3.01; p = 0.02), and pancreatic stump closure technique (group A) (OR, 2.04; p = 0.01) as independent risk factors for POPF. The present study indicated that our modified closure technique is an additional useful technique to reduce POPF after DP.


Distal pancreatectomy DP Pancreatic fistula POPF Staple closure 


Compliance with Ethical Standards

The ethics committee of the Tsukuba Medical Center Hospital approved this study.

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological SurgeryTsukuba Medical Center HospitalTsukubaJapan
  2. 2.Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery and Organ TransplantationUniversity of TsukubaTsukubaJapan

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