The modified duct-to-mucosa pancreaticojejunostomy for small pancreatic duct during pancreaticoduodenectomy

Abstract

Purpose: Postoperative pancreatic fistulas(POPFs) due to anastomotic leak are closely related to significant morbidity and mortality following pancreaticoduodenectomy(PD).The aim of this study is to introduce modification of the conventional duct-to-mucosa (DM) pancreaticojenunostomy(PJ) and the improved outcomes of this modified PJ technique for small main pancreatic duct. Methods: The modified DM anastomosis is characterized that matching internal stent was inserted into the pancreatic duct remnant and secured with suture at the opening of the pancreatic duct to enhance sealing, prior to the anastomosis. From January 2012 to October 2017, 102 patients underwent PD for small main pancreatic duct (≤ 3mm). In total, 33 cases received conventional DM pancreaticojejunal anastomosis and 69 cases received modified DM pancreaticojejunal anastomosis. Results: The postoperative stay time, diet resumption time and timing of drain removal in the modified DM group were lower than those in conventional DM group. The overall incidence of POPFs was not significantly different between two groups. But, the clinical POPFs (grade B/C) in the modified DM group occurred less frequently than those in the conventional DM group. (4.3 % vs. 24.2 %, p=0.002). Moreover, neither grade C POPF nor in-hospital mortality occurred in the modified DM group. In addition, multivariate analysis showed a significant difference between both groups on significant POPFs (OR 0.211, 95% CI 0.09 to 0.51, P=0.001). Conclusion: The modified DM anastomosis technique in our study is a safer anastomotic method than the traditional DM pancreaticojejunostomy technique. This new technique could effectively reduce the incidence of POPF.