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 widely used as an effective surgical treatment for pancreatic tumors, but there is currently no consensus on how to effectively prevent postoperative complications, especially pancreatic fistula. How to prevent postoperative pancreatic fistula (POPF) is a current research hotspot and our research focuses on how to solve this problem by improving surgical methods
To demonstrate the safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy (PJ) during PD, especially in the terms of preventing POPF.
To identify independent risk factors for POPF and evaluate the clinical outcomes of two anastomotic techniques (end-to-side invagination PJ versus modified duct-to-mucosa PJ).
This stud was a retrospective cohort study which collected and analyzed the information of patients undergoing PD in our hospital. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of POPF and subgroup analysis were conducted to compare the different outcomes between end-to-side invagination PJ and modified duct-to-mucosa PJ.
Anastomotic approaches, main pancreatic duct (MPD) diameter and pancreatic texture were proven to be significantly associated with the incidence of POPF. And modified duct-to-mucosa PJ could significantly decrease the POPF incidence (11.2%) and operation time (283.4 min) in patients compared with traditional end-to-side invagination.
Modified duct-to-mucosa PJ had advantages of shorter operation time and lower POPF incidence over classic end-to-side invagination PJ. Additionally, we found that anastomotic approaches, MPD diameter and pancreatic texture were major risk factors for POPF development.
Modified duct-to-mucosa PJ is effective and safe according to preliminary outcomes. It is an innovative anastomotic technique with great application prospects in PD and also has broad application prospects in future robotic or minimally invasive operations of pancreatic tumors.