Clinical outcomes of interlocking main pancreatic duct-jejunal internal bridge drainage in middle pancreatectomy: A comparative study.

Background: Middle pancreatectomy (MP) is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body, allowing for the preservation of pancreatic function. However, MP is associated with a higher risk of postoperative complications, and there's no clear consensus on which anastomotic method is preferable. In recent years, our team has developed a new method called interlocking main pancreatic duct-jejunal (IMPD-J) internal bridge drainage to MP.

Aim: To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.

Methods: Patients who underwent MP in our hospital between October 1, 2011 and July 31, 2023 were enrolled in this study. Patients were divided into two groups based on their pancreatojejunostomy technique: IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group. Demographic data (age, gender, body mass index, hypertension, diabetes, etc.) and perioperative indicators [operation time, intraoperative bleeding, clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying, etc.] were recorded and analyzed statistically.

Results: A total of 53 patients were enrolled in this study, including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejunostomy group. There were no significant differences in demographic or preoperative characteristics between the groups. Compared to traditional duct-to-mucosa pancreaticojejunostomy, IMPD-J bridge drainage had a significant shorter operation time (4.3 ± 1.3 hours vs 5.8 ± 1.8 hours, P = 0.002), nasogastric tube retention days (5.3 ± 1.7 days vs 6.5 ± 2.0 days, P = 0.031), lower incidence of delayed gastric emptying (8.7% vs 36.7%, P = 0.019), and lower incidence of CR-POPF (39.1% vs 70.0%, P = 0.025). Multivariate logistic regression analysis showed that pancreaticojejunostomy type (odds ratio = 4.219, 95% confidence interval = 1.238-14.379, P = 0.021) and plasma prealbumin (odds ratio = 1.132, 95% confidence interval = 1.001-1.281, P = 0.049) were independent risk factor for CR-POPF. In IMPD-J bridge drainage group, only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.

Conclusion: Compared to traditional duct-to-mucosa pancreatojejunostomy, IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications, with favorable long-term outcomes.