Suture versus stapler in distal pancreatectomy and its impact on postoperative pancreatic fistula

Abstract

Postoperative pancreatic fistula is a critical complication after distal pancreatectomy. The aim of this systematic review is to assess new reports on the main pancreatic stump closure techniques (stapler and hand-sewn suture) in distal pancreatectomy, to define their influence on postoperative pancreatic fistula rates. A literature review was performed following PRISMA guidelines (PROSPERO: CRD42023408181). The survey was conducted in Medline (via PubMed) and EMBASE. Clinical trials and cohorts were included if they assessed pancreatic fistula rates after distal pancreatectomy, and excluded if they used a fistula rating system other than the ISGPF one. The risk of bias was assessed using the Study Quality Assessment Tools | NHLBI, NIH. A meta-analysis was presented as forest-plots. Eleven articles were included, representing 1498 patients. No significant difference was found between Suture and Bare stapler (95% CI 0.91-1.68) or Bare stapler and Reinforced stapler for A-graded fistula rates (95% CI 0.78-1.28) and B-graded fistula rates (I-squared = 0.0%, p = 0.784). Most articles showed unclear risk of detection bias. This meta-analysis found no difference in fistula rates between stump closure techniques. This choice should be made by surgeons' and hospital administration's preferences.

Keywords: Fistula; Pancreatectomy; Surgical staplers; Surgical suture.

Fig. 1

Research flow.

Fig. 2

Graph of risk analysis of general bias in articles.

Fig. 3

Summary of risk analysis of general articles bias.

Fig. 4

Forest Plot for fistula grade A rate for Suture (control group) vs Bare Stapler.

Fig. 5

Forest Plot for fistula grade A rate for Bare Stapler (control group) vs Reinforced Stapler.

Fig. 6

Forest Plot for fistula grade B/C rate for Bare Stapler (control group) vs Reinforced Stapler.