Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: A meta-analysis

Table 4 Technique of pancreatic stump closure

Ref.		Technique description
Aly et al[23]	LDP	The pancreatic parenchyma was transected using a laparoscopic linear stapler
	ODP	The pancreatic parenchyma was transected using a scalpel, and the main pancreatic duct was ligated using nonabsorbable sutures. The pancreatic stump was closed with fish-mouth sutures. A linear stapler was used to transect the pancreatic parenchyma
Baker et al[24]	LDP	The gland was divided by one of 3 mechanisms: vascular stapler, harmonic scalpel, or harmonic scalpel following ablation at the pancreatic resection margin with the Habib 4*3 microsealer device
	ODP	Directly ligate the pancreatic duct when visible with a monofilament absorbable suture. The neck of the gland was oversewn with nonabsorbable monofilament suture
Butturini et al[25]	LDP	The pancreatic body was transected by a linear endostapler
	ODP	Pancreatic parenchyma was sharply transected. The main pancreatic duct was closed with nonabsorbable sutures (polypropylene 4/0). Subsequently the pancreatic stump was oversewn with interrupted mattress nonabsorbable sutures or closed using a linear stapler
Casadei et al[26]	LDP	The pancreas was divided at the neck using an endo-GIA instrument
	ODP	The pancreas was divided using GIA 55
DiNorcia et al[27]	LDP	Sutures, staples, sutures and staples combined, or staples with bioabsorbable staple-line reinforcement
	ODP
Eom et al[28]	LDP	The pancreas was transected using the 48- or 35-mm vascular endoscopic linear stapler
	ODP	The pancreatic parenchyma was divided using a blade and electrocautery. The main pancreatic duct was ligated with nonabsorbable sutures, and the transected pancreas was occluded with interlocking interrupted mattress sutures of 4-0 black silk and reinforced with 4-0 polypropylene
Jayaraman et al[29]	LDP	The pancreas was stapled using a vascular stapler with or without a Seamguard attachment
	ODP	Ligate pancreas with staples, or via suture ligation, or a combination of techniques
Kim et al[30]	LDP	For pancreatic transaction, straight endoscopic linear staplers of various sizes (staple height, 3.5-4.2 mm) were used according to the thickness or hardness of the pancreas. Four or five small titanium clips were applied along the stapling line
	ODP	The pancreatic stump underwent main duct ligation, multiple suture ligation of the branch duct exposed at the resection margin, and reinforcement of the mattress suture to the pancreas stump
Vijan et al[31]	LDP	The pancreatic parenchyma is divided with the harmonic scalpel (preferred) or with an Endo GIA stapler
	ODP	NA

LDP: Laparoscopic distal pancreatectomy; ODP: Open distal pancreatectomy; NA: Not available; GIA: Gastrointestinal incision anastomose.