Decrease in clinically relevant pancreatic fistula by coverage of the pancreatic remnant after distal pancreatectomy

Abstract

Background: Pancreatic fistulas after distal pancreatectomy occur in up to 60% of patients with distal pancreatectomy. Several techniques for closure of the pancreatic stump have been advocated, but the best management of stump closure remains controversial. Our aim was to evaluate the clinical benefits of coverage of the pancreatic resection margin by autologous tissue.

Methods: One hundred seventeen consecutive patients underwent distal pancreatectomy at the university hospital in Heidelberg between May 2009 and September 2010. A coverage procedure was performed in 73 of these patients. All patients were recorded prospectively, and the clinical course was evaluated focusing on the occurrence of pancreatic fistula as defined by the International Study Group on Pancreatic Fistula. A treatment cost analysis was performed.

Results: The rate of clinically relevant pancreatic fistulas (types B and C) was decreased in patients with coverage compared to the standard controls (type B, 7% vs 9%; type C, 7% vs 25%; P < .002). Patients with a coverage procedure had a shorter duration of stay in the hospital (P < .02), and treatment costs were lower (P < .001) compared to patients without coverage.

Conclusion: Coverage of the pancreatic remnant after distal pancreatectomy decreases the rate of clinically relevant pancreatic fistulas, duration of stay, and treatment costs. A randomized trial is needed to verify these results.