Modified Heidelberg (Buchler's) Technique of Pancreaticojejunostomy after Pancreaticoduodenectomy and Its Implications on Postoperative Pancreatic Fistula.

Abstract

Introduction: With the advancement in surgical techniques, the mortality after pancreaticoduodenectomy (PD) has significantly decreased, but the morbidity remains the same. The occurrence of postoperative pancreatic fistula (POPF) directly affects morbidity, and many pancreatic reconstruction techniques have been developed to decrease the rates of clinically relevant postoperative pancreatic fistula (CR-POPF).

Materials and methods: Our modified Heidelberg (Buchler's) technique differs from the original in the aspect that continuous sutures rather than intermittent sutures are used in all layers of the anastomosis. The outcomes of this technique were analyzed, and factors associated with POPF and CR-POPF were determined. A retrospective analysis was performed on data from 78 patients for whom the modified Heidelberg technique was used to perform pancreatojejunostomy (PJ) after PD at our institute between 2017 and 2023. In subgroup analysis, the incidence of POPF was compared between the initial phase when other PJ techniques were still practiced at our institute and the period after the technique was standardized.

Results: The incidence of CR-POPF was 6.4%, and the overall incidence of POPF was 33.3%. Postpancreatectomy hemorrhage occurred in 7.6% of the patients, and the 30-day mortality rate was 5.1%. Following standardization, the incidence of CR-POPF was significantly reduced to 4%. Prior biliary stenting and soft pancreas were risk factors for the development of POPF (p < 0.05).

Conclusion: The outcomes of PD tended to improve with the use of a single pancreatic anastomosis technique. Our modification of the Heidelberg technique of PJ is easy to perform and produces outcomes equivalent to the original Heidelberg technique. Our analysis showed that prior biliary stenting, soft pancreas, and intraoperative pancreatic duct stent placement increased the incidence of POPF, and CR-POPF was significantly associated with morbidity.

How to cite this article: Chalamalasetti K, Sankareswaran S, Raju P, et al. Modified Heidelberg (Buchler's) Technique of Pancreaticojejunostomy after Pancreaticoduodenectomy and Its Implications on Postoperative Pancreatic Fistula. Euroasian J Hepato-Gastroenterol 2025;15(1):100-106.