Background
The ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated, and postoperative pancreatic fistula (POPF) is one of the most common complications after PD. The aim of the study was to assess the surgical outcomes of four techniques of pancreatic anastomosis: duct-to-mucosa pancreaticojejunostomy (DMPJ), invagination (binding) pancreaticojejunostomy (IPJ), duct-to-mucosa pancreaticogastrostomy (DMPG), and invagination pancreaticogastrostomy (IPG).
Patients and methods
Consecutive patients treated by PD at our center were randomized into either group. The primary outcome measure was the rate of POPF, delay gastric emptying (DGE), and postpancreatictomy hemorrhage (PPH), and secondary outcomes included operative time, postoperative morbidity, and mortality using the Clavien–Dindo score.
Results
A total of 120 patients treated with PD were randomized. POPF developed in 9/42 patients in DMPJ, 4/27 patients in IPJ, 8/26 patients in DMPG, and 6/25 patients in IPG (=0.428). Delayed gastric emptying developed in 14/42 patients in DMPJ, 7/27 patients in IPJ, 9/26 patients in DMPG, and 6/25 patients in IPG (=0.065). Postpancreatictomy hemorrhage developed in 3/42 patients in DMPJ, 2/27 patients in IPJ, 3/26 patients in DMPG, and 3/25 patients in IPG (=0.670). The median operative time was significantly shorter in IPG (370 ± 78.6) and DMPG (420.9 ± 69.16 min) than IPJ (422.4 ± 90.8) and DMPJ (458.5 ± 84.3) (=0.003). There was no statistically significant difference regarding the Clavien–Dindo score.
Conclusion
There are many pancreatoenteric anastomosis techniques either in the jejunum or stomach and it should depend on the surgeon’s experience, the size of the pancreatic duct, and the texture of the pancreas. IPG and IPJ are easier to perform than DMPG and DMPJ, especially in the small pancreatic duct.