Summary of findings for the main comparison. Stapler versus scalpel resection followed by hand‐sewn closure of the pancreatic remnant for distal pancreatectomy for distal pancreatectomy.
| Stapler versus scalpel resection followed by hand‐sewn closure of the pancreatic remnant for distal pancreatectomy | |||||
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Patient or population: patients with distal pancreatectomy
Setting: Elective operations at primary and secondary care centres Intervention: stapler Comparison: hand‐sewn | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Hand‐sewn | Stapler | ||||
| Postoperative Pancreatic Fistula | 363 POPF per 1000 participants | 350 POPF per 1000 participants (102 less POPF to 81 more POPF per 1000 participants) |
RR 0.90 (0.55 to 1.45) |
381 (2 studies) | ⊕⊕⊕⊝ moderatea |
| Mortality | 11 deaths per 1000 participants | 6 deaths per 1000 participants (6 less deaths to 26 more deaths per 1000 participants) |
RR 0.49 (0.05 to 5.40) |
381 (2 studies) | ⊕⊕⊕⊝ moderatea |
| Operation Time | — | The mean operation time in the intervention groups was 15 min less (52 min shorter to 22 min longer) |
MD −14.98 min (− 52.82 to 22.87) |
381 (2 studies) | ⊕⊕⊕⊝ moderatea |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
aAlthough Bassi 1999 was unblinded, this fact is unlikely to bias pooled results, and we consider this as having a low risk of bias. However, there was serious imprecision (due to the small number of events and the wide confidence intervals) that cannot exclude clinically important benefit or harm with stapler versus hand‐sewn closure.