Elkomos Beshoy Effat, Elkomos Philopateer Effat, Salem Amir Ali, Adly Philobater Bhgat
Department of General Surgery, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt.
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Minim Access Surg. 2022 Jul-Sep;18(3):338-345. doi: 10.4103/jmas.jmas_47_22.
In the era of minimally invasive procedures and as a way to decrease the incidence of post-operative pancreatic fistula (POPF), the use of staplers for distal pancreatectomy (DP) has increased dramatically. Our aim was to investigate whether reinforced staplers decrease the incidence of clinically relevant PF after DP compared with staplers without reinforcement.
PubMed, Scopus, Web of Science and Cochrane Library were searched for eligible studies from inception to 1 November 2021, and a systematic review and a meta-analysis were done to detect the outcomes after using reinforced staplers versus standard stapler for DP.
Seven studies with a total of 681 patients were included. The overall incidence of POPF and the incidence of Grade A POPF after DP are similar for the two groups (overall POPF, risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.71-1.01, P = 0.06; I = 38% and Grade A POPF, RR = 1.15, 95% CI = 0.78-1.69, P = 0.47; I = 49%). However, the incidence of clinically significant POPF (Grades B and C) is significantly lower in DP with reinforced staplers than DP with bare staplers (Grades B and C, RR = 0.45, 95% CI = 0.29-0.71, P = 0.0005; I = 17%). Nevertheless, the time of the operation, the blood loss during surgical procedure, the hospital stay after the surgery and the thickness of the pancreas are similar for both techniques.
Although staple line reinforcement after DP failed to prevent biochemical PF, it significantly reduced the rate of clinically relevant POPF in comparison to standard stapling.
在微创外科手术时代，作为降低术后胰瘘（POPF）发生率的一种方法，吻合器在胰体尾切除术（DP）中的应用显著增加。我们的目的是研究与未加固的吻合器相比，加固吻合器是否能降低DP术后临床相关胰瘘的发生率。
检索PubMed、Scopus、Web of Science和Cochrane图书馆，查找从数据库建立至2021年11月1日的符合条件的研究，并进行系统评价和荟萃分析，以检测在DP中使用加固吻合器与标准吻合器后的结果。
纳入7项研究，共681例患者。两组DP术后POPF的总体发生率和A级POPF的发生率相似（总体POPF，风险比[RR]=0.85，95%置信区间[CI]=0.71-1.01，P=0.06；I²=38%；A级POPF，RR=1.15，95%CI=0.78-1.69，P=0.47；I²=49%）。然而，使用加固吻合器的DP中临床显著POPF（B级和C级）的发生率明显低于使用普通吻合器的DP（B级和C级，RR=0.45，95%CI=0.29-0.71，P=0.0005；I²=17%）。尽管如此，两种技术的手术时间、手术过程中的失血量、术后住院时间和胰腺厚度相似。
虽然DP术后吻合器钉合线加固未能预防生化性胰瘘，但与标准吻合相比，它显著降低了临床相关POPF的发生率。
