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Review
. 2022 Jul-Sep;18(3):338-345.
doi: 10.4103/jmas.jmas_47_22.

The outcome of bioabsorbable staple line reinforcement versus standard stapler for distal pancreatectomy: A systematic review and meta-analysis

Beshoy Effat Elkomos  1 , Philopateer Effat Elkomos  2 , Amir Ali Salem  1 , Philobater Bhgat Adly  1
Affiliations
Review

The outcome of bioabsorbable staple line reinforcement versus standard stapler for distal pancreatectomy: A systematic review and meta-analysis

Beshoy Effat Elkomos et al. J Minim Access Surg. 2022 Jul-Sep.

Abstract

Background and aim: In the era of minimally invasive procedures and as a way to decrease the incidence of post-operative pancreatic fistula (POPF), the use of staplers for distal pancreatectomy (DP) has increased dramatically. Our aim was to investigate whether reinforced staplers decrease the incidence of clinically relevant PF after DP compared with staplers without reinforcement.

Methods: PubMed, Scopus, Web of Science and Cochrane Library were searched for eligible studies from inception to 1 November 2021, and a systematic review and a meta-analysis were done to detect the outcomes after using reinforced staplers versus standard stapler for DP.

Results: Seven studies with a total of 681 patients were included. The overall incidence of POPF and the incidence of Grade A POPF after DP are similar for the two groups (overall POPF, risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.71-1.01, P = 0.06; I2 = 38% and Grade A POPF, RR = 1.15, 95% CI = 0.78-1.69, P = 0.47; I2 = 49%). However, the incidence of clinically significant POPF (Grades B and C) is significantly lower in DP with reinforced staplers than DP with bare staplers (Grades B and C, RR = 0.45, 95% CI = 0.29-0.71, P = 0.0005; I2 = 17%). Nevertheless, the time of the operation, the blood loss during surgical procedure, the hospital stay after the surgery and the thickness of the pancreas are similar for both techniques.

Conclusion: Although staple line reinforcement after DP failed to prevent biochemical PF, it significantly reduced the rate of clinically relevant POPF in comparison to standard stapling.

Keywords: Distal pancreatectomy; pancreatic fistula; reinforcement; stapler.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
PRISMA flow diagram
Figure 2
Figure 2
Overall incidence of POPF. POPF: Post-operative pancreatic fistula, CIs: Confidence intervals, RRs: Risk ratios, RCTs: Randomised controlled trials, df: Degree of freedom, IV: Inverse variance
Figure 3
Figure 3
Incidence of biochemical POPF. POPF: Post-operative pancreatic fistula, CIs: Confidence intervals, RRs: Risk ratios, RCTs: Randomised controlled trials, df: Degree of freedom, IV: Inverse variance
Figure 4
Figure 4
Incidence of clinically significant POPF. POPF: Post-operative pancreatic fistula, CIs: Confidence intervals, RRs: Risk ratios, RCTs: Randomised controlled trials, df: Degree of freedom, IV: Inverse variance
Figure 5
Figure 5
Blood loss during the operation. CIs: Confidence intervals, RCTs: Randomised controlled trials, SD: Standard deviation, df: Degree of freedom, IV: Inverse variance
Figure 6
Figure 6
Duration of the operation. CIs: Confidence intervals, RCTs: Randomised controlled trials, SD: Standard deviation, df: Degree of freedom, IV: Inverse variance
Figure 7
Figure 7
Hospital stay. CIs: Confidence intervals, RCTs: Randomised controlled trials, SD: Standard deviation, df: Degree of freedom, IV: Inverse variance
Figure 8
Figure 8
Thickness of the pancreases
See this image and copyright information in PMC

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