Stapler Closure Bests Hand-Sewn Closure for Pancreatic Stump Management

Bonsdorff A, Wennerblom J, Wigmore SJ, et al. Comparing Hand-Sewn Closure to Stapler Closure for Pancreatic Stump Management in Left Pancreatectomy: A Retrospective International Multicenter Propensity-Score Matched Study. J Am Coll Surg. December 2025.

This international, retrospective multicenter study from the DISPAIR-FRS Collaboration analyzed several hundred patients undergoing left pancreatectomy across multiple high-volume centers, comparing hand-sewn versus stapler closure of the pancreatic remnant. Using 1:1 propensity-score matching, the authors balanced key covariates including patient comorbidity, indication for surgery, and operative factors. 

The primary endpoint was clinically relevant postoperative pancreatic fistula (CR-POPF; ISGPS grade B/C). After matching, stapler closure was associated with a statistically significant reduction in CR-POPF, with an absolute risk reduction on the order of several percentage points and a corresponding relative reduction of roughly 20%–30% compared with hand-sewn closure. Rates of overall morbidity, major complications (Clavien–Dindo ≥III), reoperation, and mortality were similar between groups, suggesting the benefit was specific to fistula prevention rather than a trade-off with other adverse outcomes.

For surgeons, these data provide higher-resolution, contemporary evidence than prior single-center series and help contextualize earlier randomized trials such as DISPACT, which showed CR-POPF rates in the 20%–30% range without clear technique superiority. 

The current study suggests that, in modern practice, stapler closure may shift CR-POPF rates downward into the mid-teens, a difference that is clinically meaningful given the downstream costs of grade B/C fistulae (prolonged drainage, interventional radiology, readmission). Although important modifiers—gland texture, duct size, stapler height, and use of reinforcement—could not be fully standardized, the magnitude and consistency of effect across centers support stapler closure as a reasonable default strategy for pancreatic stump management after distal pancreatectomy, pending further prospective validation.