Background/aims: Most efforts to minimize pancreatic fistula after distal pancreatectomy (DP) have been focused on techniques of pancreatic transection and management of the pancreatic remnant. However, an ideal method of handling remnant pancreas after resection does not exist. This study evaluates surgical outcome of DP and describes how to reduce pancreatic fistula (PF) after DP.
Methodology: From March 1999 to May 2011, 142 DPs were performed at Ajou University Medical Center.
Results: The rate of pancreatic leak was 23.2% (33/142); grade A (n=18), grade B (n=15), and grade C (n=0). The remnant pancreas was managed by stapler in 44 patients (31.0%), suture in 45 (31.7%), and stapler with suture in 53 (37.3%). The morbidity and mortality rates were 38.0% and 0%. In patients who underwent surgery for extrapancreatic disease, the rate of PF was 50% (25/50). It was significantly higher than that (11.9%) in those with pancreatic disease (p = 0.003). Among closure methods for the remnant pancreas, the stapler with suture method reduced postoperative PF. In those with pancreatic disease, the PF rate after stapler with suture was significantly lower than that with stapler or suture alone.
Conclusions: Surgery for extrapancreatic disease is an independent risk factor for PF after DP. Of the methods of handling pancreatic remnants, the stapler with suture method by an experienced hepatobiliary surgeon decreased the risk of PF.