Efficacy of Modified Technique in Pancreatojejunostomy to Prevent Postoperative Pancreatic Fistula after Pancreatoduodenectomy

Naokazu Chiba,Motohide Shimazu

doi:10.4172/2165-7092.1000174

Abstract

Introduction: In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity. We present a modification for duct to mucosa pancreaticojejunostomy. Materials and Methods: Total 134 patients, who had undergone PD or pylorus preserving PD (PPPD) between November 2007 and October 2013 at our institution, were analyzed. From April 2012 to December 2014, 53 consecutive patients underwent PD or PPPD by the new modified technique and 81 patients by the former technique before March 2012. The preoperative demographics and clinical information were retrospectively obtained from both groups and were analyzed along with risk factors of POPF. Moreover, risk factors for POPF grade B/C were analysed by univariate and multivariate analysis. Results: Operation procedures were pylorus preserving PD in 119 and PD in 15. Incidence of POPF grade B/C was 11% in the new method, which was significantly lower than in the former method (38%) (p=0.0135). Moreover, risk factors for POPF grade B/C in univariate analysis were texture of pancreas (p=0.0004), dilatation of pancreatic duct (p=0.0100), and anastomosis method (p=0.0135). In multivariate analysis, risk factors were texture of pancreas (p=0.0010) and anastomosis method (p=0.053). Conclusions: The new technique in pancreticojejunostomy was safe and reliable with low POPF grade B/C rate.

Highlights

In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity
Postoperative pancreatic fistula (POPF) (5–29%) remains the single most important cause of morbidity, which can lead to prolonged hospitalizations, the need for repeated surgical interventions, and increased mortality rates [5]
Because POPF may strongly associate with other complications and affect the short- and long-term outcomes, an uncomplicated course is important for the patients who undergo PD or pylorus-preserving pancreatoduodenectomy (PPPD) [19,20]

Summary

Introduction

In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity. Advances in perioperative management and surgical techniques have made PD a relatively safe surgical procedure, with a mortality rate lower than 5% [4]. Postoperative pancreatic fistula (POPF) (5–29%) remains the single most important cause of morbidity, which can lead to prolonged hospitalizations, the need for repeated surgical interventions, and increased mortality rates [5]. The surgical technique is one improvable aspect that might reduce the pancreatic leakage rate after PD [6]. Several pancreatic anastomotic techniques have been proposed and tested, including end-to-side, with or without duct-tomucosa anastomosis, end-to-end invagination and, arguably, anastomosis of the remnant pancreas with the stomach is an additional method, it is still debated which of them has any clear advantage [7,8]

Methods

Results

Conclusion