Efficacy of Stapler versus Hand-Sewn Closure After Distal Pancreatectomy (DISPACT): A Randomised, Controlled Multicentre Trial
Diener MK, Seiler CM, Rossion I, et al.
Lancet. 2011;377:1514-1522
Summary
Pancreatic fistulas are a frequent occurrence after distal pancreatic resection. In this large multicenter report, the authors compared stapling and hand-sewn closure after resectional therapy with regard to the frequency of pancreatic fistulas or death. Of 450 patients, 352 were included in the study for analysis. Patients were recruited in 21 European hospitals, and most had benign pancreatic disease. The patients were randomly assigned to either a stapler device or hand-sewing for attaching the residual pancreas to the gastrointestinal tract. Fistula formation was frequent, occurring in 30% of the overall group, but the type of anastomosis had no impact on the occurrence of this complication (P = .056).
Viewpoint
As revealed by these data, pancreatic fistula formation is a frequent complication of resectional therapy. The large sample size means that the negative finding is unlikely to be a type 2 error and indicates that both hand-sewing and mechanical stapling methods are equivalent with respect to fistula formation. This multicenter study reminds us of the frequency of postoperative pancreatic fistulas, a serious complication, and the need for additional research on new methods to prevent fistula formation.
Abstract