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Meta-analysis and trial sequential analysis of pancreatic stump closure using a hand-sewn or stapler technique in distal pancreatectomy
Ann Hepatobiliary Pancreat Surg
Published online March 25, 2024;  https://doi.org/10.14701/ahbps.24-015
Copyright © 2024 The Korean Association of Hepato-Biliary-Pancreatic Surgery.

Shahin Hajibandeh1,*, Shahab Hajibandeh2,*, Mohammed Abdallah Hablus1,3, Hassaan Bari1, Adithya Malolan Pathanki1, Majid Ali1, Jawad Ahmad1, Gabriele Marangoni1, Saboor Khan1, For Tai Lam1

1Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire, Coventry, UK,
2Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK,
3Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Correspondence to: Shahin Hajibandeh, FRCS
Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry & Warwickshire, Coventry CV2 2DX, UK
Tel: +44-7766656058, E-mail: shahin_hajibandeh@yahoo.com
ORCID: https://orcid.org/0000-0001-6159-1068

*These authors contributed equally to this study.
Received January 17, 2024; Revised February 20, 2024; Accepted February 20, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search was carried out using multiple data sources to identify studies that compared hand-sewn and stapler closure techniques in management of pancreatic stump following DP. Odds ratio (OR) was determined for clinically relevant postoperative pancreatic fistula (POPF) via random-effects modelling. Subsequently, trial sequential analysis was performed. Thirty-two studies with a total of 4,022 patients undergoing DP with hand-sewn (n = 1,184) or stapler (n = 2,838) closure technique of pancreatic stump were analyzed. Hand-sewn closure significantly increased the risk of clinically relevant POPF compared to stapler closure (OR: 1.56, p = 0.02). When stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.54, p = 0.002). When only randomized controlled trials were considered, there was no significant difference in clinically relevant POPF between hand-sewn and stapler closure techniques (OR: 1.20, p = 0.64) or between reinforced and standard stapler closure techniques (OR: 0.50, p = 0.08). When observational studies were considered, hand-sewn closure was associated with a significantly higher rate of clinically relevant POPF compared to stapler closure (OR: 1.59, p = 0.03). Moreover, when stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.55, p = 0.02). Trial sequential analysis detected risk of type 2 error. In conclusion, reinforced stapler closure in DP may reduce risk of clinically relevant POPF compared to hand-sewn closure or stapler closure without reinforcement. Future randomized research is needed to provide stronger evidence.
Keywords : Pancreatic stump; Stapler closure; Hand-sewn closure; Distal pancreatectomy

 

May 2024, 28 (2)