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World J Gastrointest Surg. 2012 May 27;4(5):114-20. doi: 10.4240/wjgs.v4.i5.114.

Arguments for an individualized closure of the pancreatic remnant after distal pancreatic resection.

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Ulrich Friedrich Wellner, Frank Makowiec, Olivia Sick, Ulrich Theodor Hopt, Tobias Keck, Department of General and Visceral Surgery, University of Freiburg, 79106 Freiburg, Germany.



To analyze risk factors for postoperative pancreatic fistula (POPF) rate after distal pancreatic resection (DPR).


We performed a retrospective analysis of 126 DPRs during 16 years. The primary endpoint was clinically relevant pancreatic fistula.


Over the years, there was an increasing rate of operations in patients with a high-risk pancreas and a significant change in operative techniques. POPF was the most prominent factor for perioperative morbidity. Significant risk factors for pancreatic fistula were high body mass index (BMI) [odds ratio (OR) = 1.2 (CI: 1.1-1.3), P = 0.001], high-risk pancreatic pathology [OR = 3.0 (CI: 1.3-7.0), P = 0.011] and direct closure of the pancreas by hand suture [OR = 2.9 (CI: 1.2-6.7), P = 0.014]. Of these, BMI and hand suture closure were independent risk factors in multivariate analysis. While hand suture closure was a risk factor in the low-risk pancreas subgroup, high BMI further increased the fistula rate for a high-risk pancreas.


We propose a risk-adapted and indication-adapted choice of the closure method for the pancreatic remnant to reduce pancreatic fistula rate.


Body mass index; Distal pancreatic resection; Postoperative pancreatic fistula

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