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Comparing Hand-Sewn Closure to Stapler Closure for Pancreatic Stump Management in Left Pancreatectomy : A Retrospective International Multicenter Propensity Score-Matched Study

Bonsdorff, Akseli ; Wennerblom, Johanna ; Wigmore, Stephen J. ; Williamsson, Caroline LU ; Kjeseth, Trond ; Kirkegård, Jakob ; de Ponthaud, Charles ; Sparrelid, Ernesto ; Hallet, Julie and Sallinen, Ville (2026) In Journal of the American College of Surgeons 242(5). p.1348-1358
Abstract

BACKGROUND: Postoperative pancreatic fistula (POPF) is the most important complication after left pancreatectomy. Superiority of hand-sewn closure or stapler closure of pancreatic stump in terms of short-term outcomes is not established. The aim of this study was to compare short-term surgical outcomes between the 2 modalities after left pancreatectomy. STUDY DESIGN: An international, multicenter, retrospective cohort study was conducted, including patients undergoing left pancreatectomy. Patients with multivisceral resection other than splenectomy were excluded. POPF, as defined by the International Study Group for Pancreatic Surgery, was the main outcome. Patients undergoing hand-sewn closure were matched to stapler patients in a 1:1... (More)

BACKGROUND: Postoperative pancreatic fistula (POPF) is the most important complication after left pancreatectomy. Superiority of hand-sewn closure or stapler closure of pancreatic stump in terms of short-term outcomes is not established. The aim of this study was to compare short-term surgical outcomes between the 2 modalities after left pancreatectomy. STUDY DESIGN: An international, multicenter, retrospective cohort study was conducted, including patients undergoing left pancreatectomy. Patients with multivisceral resection other than splenectomy were excluded. POPF, as defined by the International Study Group for Pancreatic Surgery, was the main outcome. Patients undergoing hand-sewn closure were matched to stapler patients in a 1:1 ratio using propensity score matching. RESULTS: Altogether 2,183 patients were included, and 219 (10.0%) underwent hand-sewn closure. The overall POPF incidence was 470 (21.5%). In the matched cohort of 438 patients (219 per group), POPF incidence was significantly higher in the hand-sewn group (72 [32.9%] vs 46 |21.0%], p = 0.007). In addition, the reoperation rate was higher, and the length of hospital stay was longer in the hand-sewn group. These results were reproducible in most of the different subgroups defined by, for example, pancreatic thickness, duct diameter, and histology. CONCLUSIONS: Hand-sewn closure is associated with worse short-term outcomes, mainly increased POPF incidence, compared with stapler closure.

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type
Contribution to journal
publication status
published
subject
in
Journal of the American College of Surgeons
volume
242
issue
5
pages
11 pages
publisher
Elsevier
external identifiers
  • pmid:41395824
  • scopus:105035883395
ISSN
1879-1190
DOI
10.1097/XCS.0000000000001724
language
English
LU publication?
yes
id
f50b6ed8-ff59-41f4-91e7-a478519dfa2a
date added to LUP
2026-06-01 14:30:23
date last changed
2026-06-29 16:38:41
@article{f50b6ed8-ff59-41f4-91e7-a478519dfa2a,
  abstract     = {{<p>BACKGROUND: Postoperative pancreatic fistula (POPF) is the most important complication after left pancreatectomy. Superiority of hand-sewn closure or stapler closure of pancreatic stump in terms of short-term outcomes is not established. The aim of this study was to compare short-term surgical outcomes between the 2 modalities after left pancreatectomy. STUDY DESIGN: An international, multicenter, retrospective cohort study was conducted, including patients undergoing left pancreatectomy. Patients with multivisceral resection other than splenectomy were excluded. POPF, as defined by the International Study Group for Pancreatic Surgery, was the main outcome. Patients undergoing hand-sewn closure were matched to stapler patients in a 1:1 ratio using propensity score matching. RESULTS: Altogether 2,183 patients were included, and 219 (10.0%) underwent hand-sewn closure. The overall POPF incidence was 470 (21.5%). In the matched cohort of 438 patients (219 per group), POPF incidence was significantly higher in the hand-sewn group (72 [32.9%] vs 46 |21.0%], p = 0.007). In addition, the reoperation rate was higher, and the length of hospital stay was longer in the hand-sewn group. These results were reproducible in most of the different subgroups defined by, for example, pancreatic thickness, duct diameter, and histology. CONCLUSIONS: Hand-sewn closure is associated with worse short-term outcomes, mainly increased POPF incidence, compared with stapler closure.</p>}},
  author       = {{Bonsdorff, Akseli and Wennerblom, Johanna and Wigmore, Stephen J. and Williamsson, Caroline and Kjeseth, Trond and Kirkegård, Jakob and de Ponthaud, Charles and Sparrelid, Ernesto and Hallet, Julie and Sallinen, Ville}},
  issn         = {{1879-1190}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1348--1358}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the American College of Surgeons}},
  title        = {{Comparing Hand-Sewn Closure to Stapler Closure for Pancreatic Stump Management in Left Pancreatectomy : A Retrospective International Multicenter Propensity Score-Matched Study}},
  url          = {{http://dx.doi.org/10.1097/XCS.0000000000001724}},
  doi          = {{10.1097/XCS.0000000000001724}},
  volume       = {{242}},
  year         = {{2026}},
}