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Medline ® Abstract for Reference 45

of 'Surgical resection of lesions of the body and tail of the pancreas'

Meta-analysis of bioabsorbable staple line reinforcement and risk of fistula following pancreatic resection.
Jensen EH, Portschy PR, Chowaniec J, Teng M
J Gastrointest Surg. 2013 Feb;17(2):267-72. Epub 2012 Sep 5.
BACKGROUND: Stapled pancreatic transection is widely used although pancreatic fistula remains a common post-surgical complication.
METHODS: We performed a meta-analysis of existing data regarding pancreatic fistula following stapled pancreatic transection, comparing bare metal staples to reinforced staple loads.
RESULTS: We identified ten manuscripts between 2007 and 2009 reporting outcomes following stapled division of the pancreas (five retrospective reviews, five prospective case series). A total of 483 stapled pancreatic resections are included in this meta-analysis. Of these, 234(48 %) were reinforced (REINF) and 249 (52 %) were bare staples (STPL). Out of 483 cases, there were a total of 100 documented pancreatic leaks (21 %). Sixty-one leaks were reported out of 249 STPL divisions (24 %), while 39 leaks were reported following REINF division (17 %). The overall relative risk of developing a pancreatic fistula following distal pancreatectomy was not significantly different comparing STPL to REINF when all studies were combined (RR 1.00, 95%CI 0.65-1.53). We further evaluated the data stratifying by study design (prospective or retrospective) and found that prospective studies reported a significantly higher risk of pancreatic fistula with STPL compared to REINF technique (RR 14.45, 95 % CI 3.15-66.21).
CONCLUSION: Reinforced staples may be a preferred method of pancreatic stump closure following distal pancreatectomy.
University of Minnesota Medical Center, 420 Delaware Street SE, MMC 195, Minneapolis, MN 55455, USA. Jense893@umn.edu