Novel Method of Stump Closure for Distal Pancreatectomy with a 75% Reduction in Pancreatic Fistula Rate

Pancreatic fistula is a significant problem for patients undergoing distal pancreatectomy with fistula rates up to 61%. Fistulas lead to substantial morbidity. The study objective was to compare radiofrequency dissector closure with traditional stump closure for distal pancreatectomy. Sixty-two patients underwent distal pancreatectomy at our institution between 2002 and 2011. Thirty-three patients had traditional stump closure compared with 29 patients who had radiofrequency closure. Fistula rates, operative times, and blood loss were compared. The control patients underwent open operation in 20 (60%) cases and laparoscopic operation in the remaining 13 (40%). Of the patients that underwent radiofrequency closure, 10 (35%) underwent open operation, and the remaining 19 (65%) patients underwent laparoscopic operation. Fistula occurred in 12 of 33 (36%) patients with traditional stump closure compared to 3 of 29 (10%) patients with radiofrequency closure (p < 0.02). Operative time (307 vs. 231 min [p < 0.002]) and blood loss (364-200 mL [p < 0.02]) were decreased in the radiofrequency closure group. Length of stay decreased from 7.8 to 6.6 days; however, this was not statistically significant. The use of radiofrequency dissector in distal pancreatectomy is effective with low rates of fistula formation. Radiofrequency closure should be studied further in prospective trials.