Efficacy of Modified Technique in Pancreatojejunostomy to Prevent Postoperative Pancreatic Fistula after Pancreatoduodenectomy

Abstract

Introduction: In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity. We present a modification for duct to mucosa pancreaticojejunostomy. Materials and Methods: Total 134 patients, who had undergone PD or pylorus preserving PD (PPPD) between November 2007 and October 2013 at our institution, were analyzed. From April 2012 to December 2014, 53 consecutive patients underwent PD or PPPD by the new modified technique and 81 patients by the former technique before March 2012. The preoperative demographics and clinical information were retrospectively obtained from both groups and were analyzed along with risk factors of POPF. Moreover, risk factors for POPF grade B/C were analysed by univariate and multivariate analysis. Results: Operation procedures were pylorus preserving PD in 119 and PD in 15. Incidence of POPF grade B/C was 11% in the new method, which was significantly lower than in the former method (38%) (p=0.0135). Moreover, risk factors for POPF grade B/C in univariate analysis were texture of pancreas (p=0.0004), dilatation of pancreatic duct (p=0.0100), and anastomosis method (p=0.0135). In multivariate analysis, risk factors were texture of pancreas (p=0.0010) and anastomosis method (p=0.053). Conclusions: The new technique in pancreticojejunostomy was safe and reliable with low POPF grade B/C rate.