Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy

Background: Pancreatic fistula and intra-abdominal fluid collection are the commonest complications after distal pancreatectomy. Several techniques have been described to achieve perfect closure of the stump. Methods: In this randomized clinical trial the stapler technique was compared with stapling combined with a seromuscular patch. Seventy patients who underwent distal pancreatectomy were randomized between January 2002 and December 2006 to either closure of the pancreatic stump by stapler (35 patients) or closure by stapler and covering with a seromuscular patch of jejunum (35). The primary endpoint was the rate of postoperative fistula and/or intra-abdominal fluid collections. Results: The overall rate of these pancreas-related complications was higher in the stapling-alone group. However, rates of clinically relevant postoperative complications (grade B or C fistula and/or fluid collection requiring treatment) were comparable. The reintervention rate and median hospital stay were similar in both groups. Conclusion: Covering the stapled pancreatic remnants with a seromuscular patch is a simple method that decreased overall pancreas-related complications such as fistula. This technique did not affect clinically relevant outcomes as severe complications requiring treatment were similar with both techniques.