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NESS 2006 Annual Meeting
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Staple Line Reinforcement Reduces Postoperative Pancreatic Stump Leak After Distal Pancreatectomy
Arun Mavanur1, Mark Takata1, William P Macaulay1,2, Rocco Orlando, III1,2, Robert J Piorkowski1,2, Ramon E Jimenez1,2
1University of Connecticut Medical School, Farmington, CT;2Hartford Hospital, Hartford, CT

Objective: Evaluate whether reinforcement of the staple line at the time of distal pancreatectomy is effective in reducing pancreatic leak rate.
Design: Consecutive patient series. Before-after trial.
Setting: Large community teaching hospital.
Patients: All patients undergoing distal pancreatectomy with stapled pancreatic transection between 9/2003 and 4/2006 were included. All operations were done on an elective basis. Patients were entered into the study in consecutive fashion. All patients operated after June 2005 had staple line reinforcement.
Interventions: Staple line reinforcement involved addition of a biodegradable buttress mat (Seamguard, W.L. Gore) to the stapler system.
Main Outcome Measures: Development of pancreatic stump leak in the postoperative period (30 days). Pancreatic leak included fistulas and fluid collections (sterile or infected). Fistula was defined as surgical drain output greater than 30ml of amylase-rich fluid beyond postoperative day 5.
Results: Twenty-eight patients were recruited. Mean age was 64; 54% were female. The most common diagnoses included neuroendocrine neoplasm (29%), adenocarcinoma (25%), and cystic neoplasm (21%). Eighteen patients had stapled pancreatic transection without reinforcement (control group), and 10 subsequent patients had staple line reinforcement (experimental group). Morbidity was 39%, and mortality was zero. Postoperative pancreatic leak rate was 33% in the control group, and zero in the experimental group (p=0.062). Development of pancreatic leak resulted in prolonged hospital stays (14.8 vs. 8.4 days, p<0.02).
Conclusions: Staple line reinforcement is a simple and effective method of reducing pancreatic stump leakage after distal pancreatectomy. The economic impact of lower leak rates is reflected in significantly shorter hospital stays.

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