Application of reinforced U-shaped suture technique in laparoscopic distal pancreatectomy: an analysis of 165 consecutive cases

Postoperative pancreatic fistula (POPF) remains a major postoperative complication of laparoscopic distal pancreatectomy (LDP) that severely impacts surgical safety and patient prognosis. This study was designed to investigate the clinical efficacy of the reinforced U-shaped suture technique in reducing the incidence of POPF after LDP, and to identify independent risk factors for POPF to provide evidence-based references for clinical practice. Data were collected from 165 patients who underwent LDP between 2018 and February 2025 in our institution. Patients were stratified into two groups based on the reinforcement technique employed for pancreatic stump closure: Group A: non-reinforced U-shaped suture with 113 patients; Group B: reinforced U-shaped suture with 52 patients. Propensity score matching (PSM) was used to balance baseline covariates between the two groups. Clinical data of all patients were collected, and univariate and multivariate logistic regression analyses were performed to screen independent risk factors for POPF, and to compare the clinical outcomes of the two groups. Using multivariate analysis, pancreatic stump reinforcement technique, including our method, and other well-known POPF risk factors were independently assessed. Multivariate logistic regression analysis identified intraoperative bleeding (≥ 345.00 mL) (OR = 8.08, 95% CI: 2.41–27.11, p < 0.001) and non reinforced U-shaped suture (Group A, Group B OR = 0.18, 95% CI: 0.05–0.65, p = 0.009) as independent risk factors for POPF. Additionally, pancreatic duct diameter ≥ 3.00 mm (OR = 0.11, 95% CI: 0.03–0.39, p < 0.001) and hard pancreatic texture (OR = 0.20, 95% CI: 0.06–0.68, p = 0.011) were identified as independent protective factors for POPF. Compared with Group A, Group B had a significantly lower incidence of clinically relevant grade B/C POPF, and presented more favorable perioperative outcomes including shorter hospital stay and lower hospitalization costs. The reinforced U-shaped suture technique is a feasible and cost-effective pancreatic stump closure method for LDP, which is associated with a lower incidence of clinically relevant grade B/C POPF and more favorable perioperative outcomes. Its proposed dual technical characteristics of staple-line mechanical stabilization and indirect pancreatic duct compression/sealing may contribute to the reduction of POPF risk, and the technique holds particular clinical value for high-risk populations awaiting further prospective validation.