Comparing Hand-Sewn Closure to Stapler Closure for Pancreatic Stump Management in Left Pancreatectomy: A Retrospective International Multicenter Propensity Score-Matched Study.

Abstract

Postoperative pancreatic fistula (POPF) is the most important complication after left pancreatectomy. Superiority of hand-sewn closure or stapler closure of pancreatic stump in terms of short-term outcomes is not established. The aim of this study was to compare short-term surgical outcomes between the 2 modalities after left pancreatectomy. An international, multicenter, retrospective cohort study was conducted, including patients undergoing left pancreatectomy. Patients with multivisceral resection other than splenectomy were excluded. POPF, as defined by the International Study Group for Pancreatic Surgery, was the main outcome. Patients undergoing hand-sewn closure were matched to stapler patients in a 1:1 ratio using propensity score matching. Altogether 2,183 patients were included, and 219 (10.0%) underwent hand-sewn closure. The overall POPF incidence was 470 (21.5%). In the matched cohort of 438 patients (219 per group), POPF incidence was significantly higher in the hand-sewn group (72 [32.9%] vs 46 |21.0%], p = 0.007). In addition, the reoperation rate was higher, and the length of hospital stay was longer in the hand-sewn group. These results were reproducible in most of the different subgroups defined by, for example, pancreatic thickness, duct diameter, and histology. Hand-sewn closure is associated with worse short-term outcomes, mainly increased POPF incidence, compared with stapler closure.