Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain

  • Safi DokmakEmail author
  • Fadhel Samir Ftériche
  • Roberto Luca Meniconi
  • Béatrice Aussilhou
  • Igor Duquesne
  • Genaro Perrone
  • Chihebeddine Romdhani
  • Jacques Belghiti
  • Philippe Lévy
  • Olivier Soubrane
  • Alain Sauvanet
Original Article



Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality.


Between January 2008 and December 2016, 181 LDP were performed and the pancreas was sectioned by stapler in 130 patients (72%). Patients received white (2.5 mm), blue (3.5 mm), or green (4.1 mm) staplers and the size was not based on any pre or peroperative randomization. As primary analysis of the first 84 patients (28 in each group) showed no effect of stapler size on POPF, we decided to use the white (total = 47) or blue and finally the blue (total = 55) of medium size for standardization. Drainage was obtained by multi-tubular drain (first, 79) and a small suction drain (last, 102). Risk factors of POPF were studied and grades B and C were compared to grade A or no POPF.


POPF (n = 66; 36%) was of grade A (n = 25, 14%), grade B (n = 32, 18%), and grade C (n = 9, 5%). The comparison of the three groups of staplers showed that the blue stapler was used more with a small suction drain (85 vs 23%, p < 0.0001), had lower rate of grade B POPF (p = 0.028), and a shorter hospital stay (p = 0.004). On multivariate analysis, only the use of a small suction drain was associated with significant decrease in grades B and C POPF (6 vs 44%, odds ratio 7.385 (1.919–28.418); p = 0.004).


The occurrence of POPF following LDP is influenced by the type of drainage alone and is significantly decreased with a small suction drain.


Laparoscopic approach Minimally invasive approach Pancreas Surgery Resection Pancreatic fistula Modality of drainage Stapler size cartridge 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Safi Dokmak
    • 1
    Email author
  • Fadhel Samir Ftériche
    • 1
  • Roberto Luca Meniconi
    • 1
  • Béatrice Aussilhou
    • 1
  • Igor Duquesne
    • 1
  • Genaro Perrone
    • 1
  • Chihebeddine Romdhani
    • 2
  • Jacques Belghiti
    • 1
  • Philippe Lévy
    • 3
  • Olivier Soubrane
    • 1
  • Alain Sauvanet
    • 1
  1. 1.Department of HPB surgery and liver transplantation, Beaujon Hospital, APHPUniversity Paris VIIClichyFrance
  2. 2.Department of Anesthesiology and Intensive care medicineMilitary Hospital of TunisTunisTunisia
  3. 3.Department of Gastroenterology and Pancreatic Diseases, Beaujon Hospital, APHPUniversity Paris VIIClichyFrance

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