Comparative Analysis Of The Application Of Hand-sewn And Stapler In Distal Pancreatectomy

Objective: A comparative analysis of the effects of different treatment methods of pancreatic stump on pancreatic fistula and other complications in pancreatectomy?Methods: We gather the clinical data of 158 patients who received DP from Pancreatic Center of Shengjing Hospital,China Medical University from January 2012 to May 2018.All the operation were performed by the professors who with rich experience.All the operation are open operation without other organ resection except spleen,all the complete electronic data could be consulted.According to the treatment of the pancreatic remnant,patients were divided into hand-sewn closure group(52 cases),stapler group(22 cases)and stapler closure combined with hand-sewn closure group(31 cases).The incidence of postoperative pancreatic fistula,length of stay,re-operation and mortality were compared.To compare the postoperative pancreatic fistula and other complications between hand-sewn closure group?stapler group and stapler closure combined with hand-sewn closure group.Results: There were 28 cases of grade B pancreatic fistula in the hand-sewn closure group;in the stapler group,there were 9 cases of grade B pancreatic fistula and 1 case of grade C pancreatic fistula;there were 6 cases of grade B pancreatic fistula in stapler closure combined with hand-sewn closure group.Compared with the hand-sewn closure group,the incidence of pancreatic fistula in the combined group was lower(P < 0.05);Compared with the stapler group,the incidence of pancreatic fistula in the combined group was lower(P < 0.05);There was no significant difference between the hand-sewn closure group and the stapler group;The average length of hospitalization in the hand-sewn closure group was 28.5 days,the average length of hospitalization in the stapler group was 27.3 days,the average length of hospitalization in the stapler closure combined with hand-sewn closure group was 20.4 days;The length of hospitalization of the combined group was shorter than that of the hand-sewn closure group(P < 0.05).There was no significant difference between the combined group and the stapler group for the length of hospitalization,both between the stapler group and the hand-sewn closure group.1 case in the stapler group were reoperation.None of the patients died within 30 days after operation.There was no significant difference in reoperation rate and mortality within 30 days after operation.Conclusion: The use of stapler closure combined with hand-sewn closure to treatment of the pancreatic remnant is more effective in preventing the occurrence of postoperative pancreatic fistula and shortening the length of stay than that of manual closure and closing device alone in distal pancreatectomy.