Chirurgisches Forum 2005 pp 419-420 | Cite as
Chirurgische Techniken zur Reduktion von Pankreasfisteln nach Pankreaslinksresektion — Systematisches Review und Meta-Analyse
Abstract
Background: The objective of this systematic review is to quantitatively compare surgical techniques of distal pancreatectomy regarding the frequency of postoperative pancreatic fistula. Material and methods: A systematic literature search, critical appraisal of the relevant literature, systematic review and meta-analysis (stapler-closure versus hand-sewn closure of the pancreatic remnant) were performed. Results: Ten studies out of 262 articles fulfilled inclusion criteria and were reviewed systematically. Quantitative analysis revealed gross variation of postoperative morbidity (13–63%) and the frequency pancreatic fistula (0–40%). Meta-analysis of stapler versus hand-sutured closure showed a non significant (P=0.24) combined odds ratio for occurrence of a pancreatic fistula of 0.66 (95% confidence interval 0.35 to 1.26) in favour of stapler-closure. Conclusions: An evidence-based approach of managing the pancreatic remnant following distal pancreatectomy is currently not available. Given the results of the meta-analysis, there is a trend in favour of the stapling technique. A larger randomised controlled trial is necessary to determine if stapling is superior to other techniques.
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