Abstract
BackgroundPancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy. The aim of this study is to compare the safety and efficacy of a newly developed technique, namely mesh-reinforced pancreaticojejunostomy, in comparison with the conventional use of pancreaticojejunostomy after undergoing a pancreaticoduodenectomy.MethodsData was collected from regarding 126 consecutive patients, who underwent the mesh-reinforced pancreaticojejunostomy or conventional pancreaticojejunostomy, after standard pancreaticoduodenectomy by one group of surgeons, between the time period of 2005 and 2016. This data was collected retrospectively. Surgical parameters and perioperative outcomes were compared between these two groups.ResultsA total of 65 patients received mesh-reinforced pancreaticojejunostomy and 61 underwent conventional pancreaticojejunostomy. There were no substantial differences in surgical parameters, mortality, biliary leakage, delayed gastric emptying, gastrojejunostomy leakage, intra-abdominal fluid collection, postpancreatectomy hemorrhage, reoperation, and the total hospital costs between the two groups. Pancreatic fistula rate (15 versus 34%; p = 0.013), overall surgical morbidity (25 versus 43%; p = 0.032), and length of hospital stay (18 ± 9 versus 23 ± 12 days; p = 0.016) were significantly reduced after mesh-reinforced pancreaticojejunostomy. Multivariate analysis of the postoperative pancreatic fistula revealed that the independent factors that were highly associated with pancreatic fistula were a soft pancreatic texture and the type of conventional pancreaticojejunostomy.ConclusionsThis retrospective single-center study showed that mesh-reinforced pancreaticojejunostomy appears to be a safe technique for pancreaticojejunostomy. It may reduce pancreatic fistula rate and surgical complications after pancreaticoduodenectomy.Trial registrationThis research is waivered from trial registration because it is a retrospective analysis of medical records.
Highlights
Pancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy
Considerable techniques including pancreaticojejunostomy with duct to mucosa anastomosis or intussusceptions, main duct stenting and pancreaticogastrostomy have been described for safe surgical management of pancreatic remnants; no single method has made evident to the scientific community its superiority [7,8,9,10,11,12,13]
There were no significant differences between mesh-reinforced PJ and conventional PJ with regard to age (p = 0.312), gender (p = 0.726), body mass index (p = 0.186), and the American Society of Anesthesiologists (ASA) Classification (p = 0.899)
Summary
Pancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy. The aim of this study is to compare the safety and efficacy of a newly developed technique, namely mesh-reinforced pancreaticojejunostomy, in comparison with the conventional use of pancreaticojejunostomy after undergoing a pancreaticoduodenectomy. Since August 2005, our institute has attempted to reduce the frequency of pancreatic fistula (PF) by using new method termed mesh-reinforced anastomosis [14]. We have previously reported in previous studies that this technique appears to be safe, simple, and quick [14, 15]. The purpose of this retrospective study is to compare perioperative outcomes of mesh-reinforced pancreaticojejunostomy (PJ) with the conventional surgical procedure of pancreaticojejunostomy (PJ).
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