BACKGROUND: The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. METHODS: Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay. RESULTS: Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2-20.0, p = 0.032). CONCLUSION: The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.
BACKGROUND: The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. METHODS: Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay. RESULTS: Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2-20.0, p = 0.032). CONCLUSION: The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.
Authors: Horacio J Asbun; Jony Van Hilst; Levan Tsamalaidze; Yoshikuni Kawaguchi; Dominic Sanford; Lucio Pereira; Marc G Besselink; John A Stauffer Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: Claudio Bassi; Giovanni Marchegiani; Christos Dervenis; Micheal Sarr; Mohammad Abu Hilal; Mustapha Adham; Peter Allen; Roland Andersson; Horacio J Asbun; Marc G Besselink; Kevin Conlon; Marco Del Chiaro; Massimo Falconi; Laureano Fernandez-Cruz; Carlos Fernandez-Del Castillo; Abe Fingerhut; Helmut Friess; Dirk J Gouma; Thilo Hackert; Jakob Izbicki; Keith D Lillemoe; John P Neoptolemos; Attila Olah; Richard Schulick; Shailesh V Shrikhande; Tadahiro Takada; Kyoichi Takaori; William Traverso; Charles R Vollmer; Christopher L Wolfgang; Charles J Yeo; Roberto Salvia; Marcus Buchler Journal: Surgery Date: 2016-12-28 Impact factor: 3.982
Authors: Yi Miao; Zipeng Lu; Charles J Yeo; Charles M Vollmer; Carlos Fernandez-Del Castillo; Paula Ghaneh; Christopher M Halloran; Jörg Kleeff; Thijs de Rooij; Jens Werner; Massimo Falconi; Helmut Friess; Herbert J Zeh; Jakob R Izbicki; Jin He; Johanna Laukkarinen; Cees H Dejong; Keith D Lillemoe; Kevin Conlon; Kyoichi Takaori; Luca Gianotti; Marc G Besselink; Marco Del Chiaro; Marco Montorsi; Masao Tanaka; Maximilian Bockhorn; Mustapha Adham; Attila Oláh; Roberto Salvia; Shailesh V Shrikhande; Thilo Hackert; Tooru Shimosegawa; Amer H Zureikat; Güralp O Ceyhan; Yunpeng Peng; Guangfu Wang; Xumin Huang; Christos Dervenis; Claudio Bassi; John P Neoptolemos; Markus W Büchler Journal: Surgery Date: 2020-04-02 Impact factor: 3.982
Authors: Matthias Hassenpflug; Ulf Hinz; Oliver Strobel; Johanna Volpert; Philip Knebel; Markus K Diener; Colette Doerr-Harim; Jens Werner; Thilo Hackert; Markus W Büchler Journal: Ann Surg Date: 2016-11 Impact factor: 12.969
Authors: Jörg Kleeff; Markus K Diener; Kaspar Z'graggen; Ulf Hinz; Markus Wagner; Jeannine Bachmann; Jörg Zehetner; Michael W Müller; Helmut Friess; Markus W Büchler Journal: Ann Surg Date: 2007-04 Impact factor: 12.969
Authors: Maxwell T Trudeau; Fabio Casciani; Brett L Ecker; Laura Maggino; Thomas F Seykora; Priya Puri; Matthew T McMillan; Benjamin Miller; Wande B Pratt; Horacio J Asbun; Chad G Ball; Claudio Bassi; Stephen W Behrman; Adam C Berger; Mark P Bloomston; Mark P Callery; Carlos Fernandez-Del Castillo; John D Christein; Mary E Dillhoff; Euan J Dickson; Elijah Dixon; William E Fisher; Michael G House; Steven J Hughes; Tara S Kent; Giuseppe Malleo; Ronald R Salem; Christopher L Wolfgang; Amer H Zureikat; Charles M Vollmer Journal: Ann Surg Date: 2022-02-01 Impact factor: 12.969