Two RCTs and 8 observational studies (n=1,080) were included in the review. Six of these studies (1 RCT and 5 observational studies; n=479) were included in the meta-analysis.
Overall, the methodological quality of the included studies was poor. Most of the studies were retrospective, observational studies with small sample sizes and did not use methods to minimise selection bias. In addition, there were variations in the reported definition of the outcome.
No statistically significant difference was found in the occurrence of pancreatic fistula between stapler closure and hand suture (OR 0.66, 95% CI: 0.35, 1.26, P=0.21), based on 479 patients in 6 studies. There was moderate evidence of statistical heterogeneity (I-squared 26.3%).
Across all 10 included studies, the rate of pancreatic fistula ranged from 0 to 60.9% and the reported post-operative morbidity ranged from 13.3 to 64%.