Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1405-1413
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1405
Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy
Hui Liang, Jian-Guo Wu, Fei Wang, Bo-Xuan Chen, Shi-Tian Zou, Cong Wang, Shuai-Wu Luo
Hui Liang, Fei Wang, Bo-Xuan Chen, Shi-Tian Zou, Cong Wang, Shuai-Wu Luo, Department of Hepatobiliary and Pancreas, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Jian-Guo Wu, Department of Nuclear Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Liang H and Wu JG designed the study; Wang F carried out the work; Chen BX and Zou ST collected the data; Wang C analyzed and interpreted the data, Liang H and Luo SW wrote the article.
Supported by Scientific Research Programme for Health Commission of Jiangxi Province, No. 20204269.
Institutional review board statement: Approved by the Second Affiliated Hospital of Nanchang University Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Guo Wu, PhD, Chief Doctor, Department of Nuclear Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang 330006, Jiangxi Province, China. grantwu2021@163.com
Received: April 6, 2021
Peer-review started: April 6, 2021
First decision: May 13, 2021
Revised: July 3, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: November 27, 2021
Processing time: 234 Days and 7.5 Hours
ARTICLE HIGHLIGHTS
Research background

Pancreaticoduodenectomy (PD) involves many organs, and the operation is complex and the scope of operation is large. The operation can cause significant trauma in patients and has a high rate of complications. Pancreatic leakage is the main complication after PD.

Research motivation

This study discussed the selection of surgical methods for pancreaticojejunostomy and pancreatic leakage during PD.

Research objectives

This study aimed to investigate the choice of operative methods for pancreaticojejunostomy and conduct a multivariate analysis of pancreatic leakage in PD.

Research methods

A total of 420 patients undergoing PD were selected and divided into group A and group B according to the pancreatointestinal anastomosis method adopted during the operation. Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B. The operation time, intraoperative blood loss, and pancreatic leakage in the two groups were observed, and the occurrence of pancreatic leakage after the operation in different patients was analyzed.

Research results

The differences in operative time and intraoperative bleeding between groups A and B were not significant. In group A, the duration of pancreatojejunostomy was 26.03 ± 4.40 min and the pancreatic duct diameter was 3.90 ± 1.10 mm. These measurements were significantly higher than those in group B. The differences in the occurrence of pancreatic leakage, abdominal infection, abdominal hemorrhage, and gastric retention between group A and group B were not significant. The rates of pancreatic leakage in patients with preoperative albumin < 30 g/L, preoperative jaundice time ≥ 8 wk, and pancreatic duct diameter < 3 mm were 23.33%, 33.96%, and 19.01%, respectively.

Research conclusions

The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage. The main risk factors for pancreatic leakage include preoperative albumin, preoperative jaundice time, and pancreatic duct diameter.

Research perspectives

A more advantageous surgical method for pancreaticojejunostomy should be selected.