The pancreatic dissecting line is a greater risk factor for pancreatic fistula than attaching PGA felt to the pancreatic stump. (UMIN000017156)

Abstract Purpose: Postoperative pancreatic fistula (POPF) is a potentially fatal complication of distal pancreatectomy (DP) but the optimal prevention method is unknown. The standard methodology for DP is to dissect the pancreas using a stapler alone. This pilot study evaluated post-DP remnant closure by stapling plus a PGA felt patch and examined the predictors of POPF. Methods: We prospectively enrolled and analyzed 26 patients scheduled for DP in which the remnants were closed with staples and a PGA felt patch. Results: Primary disease included 17 pancreatic adenocarcinomas, 3 pancreatic neuroendocrine neoplasms, 2 mucinous cystic neoplasms, 2 solid pseudopapillary neoplasms, and 2 other disorders. The mean main pancreatic duct diameter at the excision site was 2.3 mm. The mean pancreatic parenchyma thickness was 12.3 mm. The mean pancreatic dissected line was 0.5 mm to the left from the left edge of the portal vein. We observed nine biochemical leaks and the formation of nine grade B POPFs. We found significant differences in the BMI, pancreatic parenchymal thickness, and pancreatic dissection line between patients with and without POPF. Conclusion: Although stapling and applying PGA felt did not show efficacy in preventing POPF, the pancreatic dissecting line was suggested as a risk factor.