A new, simple and safe pancreaticojejunal anastomosis. Three Grade B pancreatic leaks after 100 consecutive procedures.

Abstract

Background: Postoperative pancreatic fistula (POPF) is the main cause of fatal complications after pancreatoduodenectomy. There is still no universally accepted technique for pancreaticojejunal anastomosis (PJA), especially in patients with soft and fragile pancreas. Methods: Pull-through M- with locking U-sutures and internal STent one-layer invaginated end-to-end PJA (MUST) has become a main anastomotic technique in our department Postoperative morbidity and 90-days mortality were evaluated in 100 consecutive patients who underwent PJA using the MUST technique between November 2014 to September 2016. The results were compared with the historical data from patients operated previously in our department by the modified Cattell–Warren (MCW) method Results: The rates of clinically relevant POPF and fistula-related mortality were significantly lower in the MUST group vs. CWA group (3% grade B and no grade C POPFs vs. 6% grade B and 4% grade C POPFs). The duration of postoperative hospital stay was significantly shorter in the MUST group Conclusion: A retrospective analysis confirmed the efficacy of MUST technique for any type of pancreatic parenchyma and any duct size. For its ultimate approval as a standard PJA technique, it should be further evaluated in prospective randomized trials.