Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Meta-analysis and trial sequential analysis of pancreatic stump closure using a hand-sewn or stapler technique in distal pancreatectomy

  • Shahin Hajibandeh (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Shahab Hajibandeh (Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales) ;
  • Mohammed Abdallah Hablus (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Hassaan Bari (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Adithya Malolan Pathanki (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Majid Ali (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Jawad Ahmad (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Gabriele Marangoni (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • Saboor Khan (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire) ;
  • For Tai Lam (Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire)
  • Received : 2024.01.17
  • Accepted : 2024.02.20
  • Published : 2024.08.31
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Abstract

This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search was carried out using multiple data sources to identify studies that compared hand-sewn and stapler closure techniques in management of pancreatic stump following DP. Odds ratio (OR) was determined for clinically relevant postoperative pancreatic fistula (POPF) via random-effects modelling. Subsequently, trial sequential analysis was performed. Thirty-two studies with a total of 4,022 patients undergoing DP with hand-sewn (n = 1,184) or stapler (n = 2,838) closure technique of pancreatic stump were analyzed. Hand-sewn closure significantly increased the risk of clinically relevant POPF compared to stapler closure (OR: 1.56, p = 0.02). When stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.54, p = 0.002). When only randomized controlled trials were considered, there was no significant difference in clinically relevant POPF between hand-sewn and stapler closure techniques (OR: 1.20, p = 0.64) or between reinforced and standard stapler closure techniques (OR: 0.50, p = 0.08). When observational studies were considered, hand-sewn closure was associated with a significantly higher rate of clinically relevant POPF compared to stapler closure (OR: 1.59, p = 0.03). Moreover, when stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.55, p = 0.02). Trial sequential analysis detected risk of type 2 error. In conclusion, reinforced stapler closure in DP may reduce risk of clinically relevant POPF compared to hand-sewn closure or stapler closure without reinforcement. Future randomized research is needed to provide stronger evidence.

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References

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