Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic f
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(2020) 18:295
RESEARCH
Open Access
Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula Hiromichi Kawaida*, Hiroshi Kono, Hidetake Amemiya, Naohiro Hosomura, Mitsuaki Watanabe, Ryo Saito, Yuuki Nakata, Katsutoshi Shoda, Hiroki Shimizu, Shinji Furuya, Hidenori Akaike, Yoshihiko Kawaguchi, Makoto Sudo, Masanori Matusda, Jun Itakura, Hideki Fujii and Daisuke Ichikawa
Abstract Background: Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods: In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results: The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions: Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.
Introduction Pancreaticoduodenectomy (PD) is still the only curative treatment option for malignant and some borderline/benign tumors of the pancreatic head and periampullary region despite the development of various other treatments. With advances in surgical techniques and perioperative management, the operative mortality of PD in high-volume centers has reduced to less than 3% [1–3]. * Correspondence: [email protected] First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
However, incidences of postoperative pancreatic fistula (POPF) have still been reported to be as high as 10% [4–7]. POPF is one of the most serious complications that can result from PD. POPF occurs when there is a pancreatic juice leakage from a surgically exfoliated surface and/or anastomosis. Many previous studies have described several risk factors for POPF, such as gender (male) [8], a high body mass index (BMI) [9], the anastomotic method [6, 10], and the use of an external stent [11]. However, the greatest risks are having a small pancreatic duct (≤ 3 mm) or a soft pancreas [6, 10, 12–17].
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