Post operative pancreatic fistula rate following pancreaticojejunostomy with Heidelberg technique versus classical duct to mucosa technique: a comparative study

Abstract

Background: The best technique for pancreatic anastomosis is still a debate and unanswered by multiple RCTs and meta-analyses, done over past two decades. This study intends to compare the outcomes of pancreatico-jejunostomy (PJ) using Heidelberg technique vs classical duct to mucosa technique Methods: All patients who underwent pancreaticoduodenectomy meeting criteria were included in study. Outcome of PJ done by Heidelberg technique evaluated by occurrence of POPF, as defined by ISGPF and results were compared to historical cohort of patients who had underwent PJ by classical duct to mucosa technique in our institution, Results: PJ reconstruction was done with Heidelberg and classical duct to mucosa technique in 20 patients each. POPF rates in Heidelberg and duct to mucosa techniques when calculated using ISGPS-2005 definition (30% vs. 40%, p=0.677 and 10% vs. 10%, p=0.514 respectively) and ISGPS-2016 definitions (10% vs. 10%, p=0.514). There is no statistical difference between the two techniques in terms of DGE, infection, and days of hospital stay or duration of drain requirement. But Heidelberg technique is superior to DM technique with respect to shorter operating time (p=0.0001) and lower Clavien-Dindo morbidity grades (p=0.0004). Though a statistical significance could not be reached, there is an increased tendency of higher grade POPF with respect to increased age (>57 years), softer texture and smaller duct size (<3 mm). Conclusions: There is no significant difference of CR-POPF rates between Heidelberg and classical duct to mucosa techniques of PJ. However, Heidelberg technique is better in terms of simplicity, reduced operating time and lower post-operative morbidity when compared to duct to mucosa technique.