Current practice in pancreatic stump management during minimally invasive distal pancreatectomy: results of a national survey from the IGOMIPS registry

Background Minimally invasive distal pancreatectomy (MIDP) has become more common in recent years, offering shorter recovery times and fewer perioperative complications compared to open surgery. However, postoperative pancreatic fistula (POPF) remains a major concern, driving the search for effective stump management strategies to minimize complications and healthcare costs. Methods Between February and March 2025, a 25-item Google Forms questionnaire was emailed to the lead surgeons of all 44 IGOMIPS centers. One response per center was requested. The questionnaire covered a wide range of topics, including the preferred surgical platform (laparoscopic vs robotic), types of transection devices (motorized or non-motorized staplers, energy-based tools), use of staple-line reinforcement, pre-firing compression durations, and postoperative drain-management practices. Descriptive analyses were performed and correlated with existing literature. Results A total of 36 invited centers, each utilizing minimally invasive surgical techniques for distal pancreatectomy, completed the survey (response rate: 81.8%, 36/44). The adopted surgical platform was robotic in 14 centers (38.9%), laparoscopic in 11 (30.6%) and mixed in 11 (30.6%). Parenchymal transection relied on motorised staplers in 24 centers (66.7%), conventional staplers in 8 (22.2%) and energy-based devices in 2 (5.6%); two centers (5.5%) tailored the device to gland thickness. Pre-firing compression lasted < 1 min in 6 centers (16.7%), 1-3 min in 16 (44.4%) and > 3 min in 6 (16.7%), while 7 centers (19.4%) had no fixed interval. Staple-line reinforcement was never used in 14 centers (38.9%), always used in 6 (16.7%) and applied selectively in the remainder. Routine prophylactic drainage was practised by 32 centers (88.9%); drains were removed < POD 5 in 14 (38.9%). Conclusion The marked heterogeneity in stump-management techniques in MIDP highlights the absence of robust, standardized guidelines, reflecting persistent controversies in the literature. Respondents expressed strong interest in future multicenter trials to establish evidence-based protocols, emphasizing that collaborative, large-scale research is crucial for improving patient outcomes and reducing the risk of POPF.