Despite an improvement regarding morbidity and mortality since 30 years, especially in expert
centers, pancreatic surgery remains currently associated to a significant postoperative
morbidity reaching more than 60%. Regarding distal pancreatectomy (DP), the main complication
following surgery is the occurrence of postoperative pancreatic fistula (PF) which may be
able to lead an increased risk of bleeding, gastroparesis and finally a longer hospital
stays. The main risk factors associated to the occurrence of pancreatic fistula are
represented by the texture of the pancreatic parenchyma (soft pancreas) and the caliber of
the main pancreatic duct (<3mm). Looking for new means of reducing the occurrence of
pancreatic fistula is a priority in pancreatic surgery and a genuine public health issue.
Currently, no formal recommendations concerning the optimal technical for closure of the
distal stump in DP are available. In fact, manual closing by elective suturing or stapling of
the main pancreatic duct give similar results. The use of a reinforcing stapling potentially
represents a simple way to decrease the occurrence of pancreatic fistula and requires
evaluation by a prospective randomized study.