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Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy

Lookup NU author(s): John Hammond, Jeremy French, Sanjay PandanaboyanaORCiD


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© 2019 BJS Society Ltd Published by John Wiley & Sons LtdBackground: The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy remains high, and different pancreatic stump closure techniques have been used to reduce the incidence. A network meta-analysis was undertaken to compare the most frequently performed pancreatic stump closure techniques after distal pancreatectomy and determine the technique associated with the lowest POPF rate. Methods: A systematic search of the Scopus, PubMed, MEDLINE and Embase databases was conducted to identify eligible RCTs. The primary outcome was the occurrence of clinically relevant POPF. Secondary outcomes were duration of operation, blood loss, intrabdominal collections, postoperative complications and 30-day mortality. Results: Sixteen RCTs including 1984 patients and eight different pancreatic stump closure techniques were included in the network meta-analysis. Patch coverage of the pancreatic stump (round ligament or seromuscular patch) after stapler or suture closure ranked best, with the lowest rates of clinically relevant POPF, lowest volume of intraoperative blood loss, fewer intra-abdominal abscesses, and lower rates of overall complications and 30-day mortality. Round ligament patch closure outperformed seromuscular patch closure in preventing clinically relevant POPF with a significantly larger cohort for comparative analysis. Pancreaticoenteric anastomotic closure consistently ranked poorly for most reported postoperative outcomes. Conclusion: Patch coverage after stapler or suture closure has the lowest POPF rate and best outcomes among stump closure techniques after distal pancreatectomy.

Publication metadata

Author(s): Ratnayake CBB, Wells C, Hammond J, French JJ, Windsor JA, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: British Journal of Surgery

Year: 2019

Volume: 106

Issue: 12

Pages: 1580-1589

Print publication date: 01/11/2019

Online publication date: 18/10/2019

Acceptance date: 30/05/2019

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/bjs.11291

PubMed id: 31626341