Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1901
Peer-review started: May 20, 2023
First decision: July 8, 2023
Revised: July 20, 2023
Accepted: August 4, 2023
Article in press: August 4, 2023
Published online: September 27, 2023
Pancreatoduodenectomy (PD) is the most effective surgical procedure to remove a pancreatic tumor, but the prevalent postoperative complications, including postoperative pancreatic fistula (POPF), can be life-threatening. Thus far, there is no consensus about the prevention of POPF.
To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy (PJ) on POPF development.
We retrospectively collected and analyzed the data of 215 patients who under
A total of 108 patients received traditional end-to-side invagination PJ, and 107 received modified duct-to-mucosa PJ. Overall, 58.6% of patients had various complications, and 0.9% of patients died after PD. Univariate and multivariate logistic regression analyses showed that anastomotic approaches, main pancreatic duct (MPD) diameter and pancreatic texture were significantly associated with the incidence of POPF. Additionally, the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2% and 283.4 min, respectively, which were significantly lower than those in patients receiving traditional end-to-side invagination PJ (27.8% and 333.2 minutes).
Anastomotic approach, MPD diameter and pancreatic texture are major risk factors for POPF development. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF. Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.
Core Tip: We evaluated the safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy (PJ) during pancreatoduodenectomy (PD) by analyzing the data of 215 patients who underwent PD in our surgery center. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ was a simpler and more efficient technique that resulted in a lower incidence of postoperative pancreatic fistula (11.2%). Meanwhile, we found that anastomotic approach, main pancreatic duct diameter and pancreatic texture were major risk factors for postoperative pancreatic fistula development.