Stapled Transection with Seamguard and Postoperative Pancreatic Fistula After Distal Pancreatectomy: A 10-year single centre experience

Introduction: Postoperative pancreatic fistula (POPF) remains the most significant complication following distal pancreatectomy. Various pancreatic stump reinforcement techniques have been described, but evidence on their efficacy is conflicting and heterogeneous. The consequent uncertainty therefore limits the development of standardised and patient-tailored management strategies in clinical practices. This retrospective observational study aims to assess the association between the use of bioabsorbable staple-line reinforcement and the development of clinically relevant POPF after distal pancreatectomy within a large Western Australian tertiary care centre. Method: This retrospective cohort study analysed patients undergoing distal pancreatectomy at Fiona Stanley Hospital (January 2015–March 2025), grouped by surgical technique at the surgeon’s discretion. The primary outcome was clinically relevant POPF as per the ISGPS definition. Multivariable logistic regression was conducted to evaluate the independent association between stump closure techniques (with particular focus on bioabsorbable staple-line reinforcement) and clinically relevant POPF, while controlling for patient-related risk factors including age, sex, body mass index, diabetes mellitus, smoking status, ASA score, and underlying pathology. Anatomic risk factors such as pancreatic texture, main pancreatic duct diameter, and stump thickness were not included in the model, as these were not routinely documented in medical records. Results: A total of 92 patients were analysed. The Seamguard reinforcement group (n = 74) had a lower incidence of Grade B POPF (23%) compared to those without reinforcement (n = 18; 50%). This protective association remained significant after adjusting for age, sex, BMI, diabetes, smoking status, and surgical approach (OR: 0.239; p = 0.022) and was unaffected by additional buttressing techniques (OR: 0.260; p = 0.024). Conclusion: This observational study suggests staple line reinforcement with Seamguard is associated with lower rates of clinically relevant POPF, and this association appears independent of additional buttressing techniques and patient related risk factors. Further investigation of this association in relation to pancreatic anatomic factors, including thickness, texture and main pancreatic duct size, is needed to develop a standardised patient-tailored approach to minimising POPF incidence.