Effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy

Abstract

Objective To investigate the effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 396 patients who received pancreaticoduodenectomy at the Cancer Hospital of Shandong Province from January 2001 to January 2011 were retrospectively analyzed. All patients were divided into the improved group （235 patients） and tradi- tional group （161 patients） according to different anastomotic methods. All tile operations were done by the same surgical group, and the digestive tract was reconstructed by the Child method. Patients in the improved group received improved end-to-end invagination pancreaticojejunostomy, and patients in the traditional group received traditional end-to-end anastomosis. The volume of operative bleeding, operation time, incidence of pancreatic fistula and duration of hospital stay of the 2 groups were compared. All data were analyzed using the t test, chi- square test or Fisher exact probability. Results The operative blood loss, operation time and duration of hospital stay were （383 ±56）ml, （7.2 ± 1.0）hours, （21±3）days in the improved group, and （381±39）ml, （7.0 ± 0.5） hours, （22 ± 5 ）days in the traditional group, with no significant difference between the 2 groups （t = 0. 388, 1. 680, - 1. 835, P 〉 0.05 ）. No operative death was detected in the 2 groups, and the overall incidence of pancreatic fistula was 7.6% （30/396）. The incidence of pancreatic fistula of the improved group was 0 （0/235）, which was significantly lower than 18.6% （30/161） of the traditional group （ P 〈 0.05 ）. Patients complicated with pancreatic fistula in the traditional group were cured by drainage, somatostatin administration and parenteral nutrition. Conclusion hnproved end-to-end invagination pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy. Key words: Periampullary neoplasms ; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancre-atic fistula