HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy

Abstract Background Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques. Method We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team. Results 36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively. Conclusion Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.