Comparing Hand-Sewn Closure to Stapler Closure for Pancreatic Stump Management in Left Pancreatectomy: A Retrospective International Multicenter Propensity Score–Matched Study
Bibliographic record
Abstract
BACKGROUND: Postoperative pancreatic fistula (POPF) is the most important complication after left pancreatectomy. Superiority of hand-sewn closure or stapler closure of pancreatic stump in terms of short-term outcomes is not established. The aim of this study was to compare short-term surgical outcomes between the 2 modalities after left pancreatectomy. STUDY DESIGN: An international, multicenter, retrospective cohort study was conducted, including patients undergoing left pancreatectomy. Patients with multivisceral resection other than splenectomy were excluded. POPF, as defined by the International Study Group for Pancreatic Surgery, was the main outcome. Patients undergoing hand-sewn closure were matched to stapler patients in a 1:1 ratio using propensity score matching. RESULTS: Altogether 2,183 patients were included, and 219 (10.0%) underwent hand-sewn closure. The overall POPF incidence was 470 (21.5%). In the matched cohort of 438 patients (219 per group), POPF incidence was significantly higher in the hand-sewn group (72 [32.9%] vs 46 |21.0%], p = 0.007). In addition, the reoperation rate was higher, and the length of hospital stay was longer in the hand-sewn group. These results were reproducible in most of the different subgroups defined by, for example, pancreatic thickness, duct diameter, and histology. CONCLUSIONS: Hand-sewn closure is associated with worse short-term outcomes, mainly increased POPF incidence, compared with stapler closure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".