Impact of Pancreatic Stump Closure Techniques on Postoperative Pancreatic Fistula after Distal Pancreatectomy

Background: Distal pancreatectomy (DP) is usually carried out for cases with malignant and benign tumors of the distalpancreas and chronic pancreatitis.Aim: To assess the safety of various pancreatic stump closure techniques in the prevention of pancreatic fistula (PF)during DP.Patients and Methods: This was a retrospective and prospective study from January 2015 to 2023 that was conducted on 47 patients with distal pancreatic lesions who were subjected to elective distal pancreatic resection in the department of hepatopancreaticobiliary operation, National Liver Institute, Menoufia University.Results: Regarding the comparison of postoperative evaluation according to type of procedure, it was found that there issignificant variance regarding PF (P<0.05), as 40% of cases who sewn DP had PF compared with 5.9% in stapler and 0% incombined stapler and hand sewing. On the other hand, no significant difference was found regarding other complications(P>0.05); however, the occurrence of these complications was nonsignificantly greater in the sewing procedure than inother procedures after the exclusion of the omental patch, as there were only two cases.Conclusion: Stapler and combined techniques (stapler and hand sewing) were correlated with a decreased probabilityof clinically relevant PF. This is because stapler closure of the pancreatic remnant enables good postoperative outcomes,thereby limiting the formation of PF to the lower limit of its overall stated occurrence.