Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy

Table 1 General information on patients in the single-layer anastomosis group

Item	Mean value	Standard deviation	Minimum value	Maximum value
Age (yr)	58.804	9.466	38.000	79.000
BMI (kg/m2	22.866	2.755	17.900	29.400
Albumin (g/L)	38.039	3.891	26.100	45.000
Blood glucose (mol/L)	6.472	2.540	3.960	16.610
Total bilirubin (μmol/L)	122.618	122.204	6.400	412.600
Alkaline phosphatase (u/L)	359.631	258.629	39.900	1396.900
r-GT	620.853	522.464	7.000	2503.200
Operation time (min)	220.059	60.602	135.000	480.000
Pancreaticojejunal anastomosis time (min)	17.922	5.145	11.000	40.000
Amount of blood loss (mL)	292.549	146.940	100.000	800.000
Pancreatic duct diameter (mm)	4.863	2.322	1.000	12.000
Hospitalization time (d)	25.627	6.551	15.000	49.000
Postoperative hospitalization time (d)	18.588	5.285	7.000	33.000
Hospitalization expense (yuan)	116787.667	31900.927	64874.000	237762.000

BMI: Body mass index.

Table 2 General information on patients in the double-layer anastomosis group

Item	Mean value	Standard deviation	Minimum value	Maximum value
Age (yr)	58.020	12.820	18.000	78.000
BMI (kg/m2)	23.858	3.272	13.360	32.690
Albumin (g/L)	39.480	4.182	29.600	50.000
Blood glucose (mol/L)	6.482	2.228	4.120	13.550
Total bilirubin (μmol/L)	73.510	78.244	3.500	313.000
Alkaline phosphatase (u/L)	303.245	268.287	42.000	1105.600
r-GT	533.655	631.956	5.800	2744.000
Operation time (min)	379.412	90.761	210.000	570.000
Pancreaticojejunal anastomosis time (min)	31.333	7.776	16.000	47.000
Amount of blood loss (mL)	482.353	293.909	50.000	1500.000
Pancreatic duct diameter (mm)	3.961	2.362	1.500	12.000
Hospitalization time (d)	33.706	15.899	16.000	105.000
Postoperative hospitalization time (d)	26.373	15.815	11.000	101.000
Hospitalization expense (yuan)	162788.608	129732.500	84497.000	968534.000

BMI: Body mass index.

Table 3 Pathology data

Pathological type	Number of cases
Distal bile duct adenocarcinoma	29
Chronic inflammation at the end of the distal bile duct mucosa combined with moderate atypical dysplasia	3
Villous adenoma at the end of distal bile duct mucosa and moderate-severe atypical dysplasia of some glands	1
Ampullary adenocarcinoma	14
Duodenal stromal tumors	1
Adenocarcinoma of the descending duodenum	3
Duodenal papilla adenocarcinoma	20
Duodenal neuroendocrine tumors	2
Tubulovillous adenoma of duodenal papilla with severe atypical dysplasia of some epithelia	1
Duodenal papilla adenocarcinoma	1
Chronic pancreatitis
Pancreatic head adenocarcinoma	22
Solid-pseudopapillary tumor of pancreatic head	1
Neuroendocrine tumor of pancreatic head	2
Neuroendocrine carcinoma of pancreatic head	1

Table 4 Comparison of patient data in the two groups, n

Item	Single-layer anastomosis group	Double-layer anastomosis group	P-value
Gender	Female: 21	Female: 19	0.6850
	Male: 30	Male: 32
Age	> 60 yr: 24	> 60 yr: 25	0.8429
	≤ 60 yr: 27	≤ 60 yr: 26
Hypertension	Yes: 6	Yes: 13	0.0750
	No: 45	No: 38
Diabetes mellitus	Yes: 10	Yes: 4	0.0843
	No: 41	No: 47
Drinking history	Yes: 14	Yes: 16	0.6638
	No: 37	No: 35
Smoking history	Yes: 13	Yes: 14	0.8224
	No: 38	No: 37
Abdominal surgery history	Yes: 5	Yes: 8	0.3731
	No: 46	No: 43
Preoperative biliary drainage	Yes: 13	Yes: 10	0.4772
	No: 38	No: 41
BMI	> 25: 13	> 25: 17	0.3847
	≤ 25: 38	≤ 25: 34
Total bilirubin	> 171 μmol/L: 16	> 171 μmol/L: 10	0.1728
	≤ 171 μmol/L: 35	≤ 171 μmol/L: 41
Serum albumin	≥ 35 g/L: 40	≥ 35 g/L: 47	0.0503
	< 35 g/L: 11	< 35 g/L: 4 cases
Blood glucose	> 6.1 mmol/L: 19	> 6.1 mmol/L: 24	0.3161
	≤ 6.1 mmol/L: 32	≤ 6.1 mmol/L: 27
Disease composition	Pancreatic head: 11	Pancreatic head: 16	0.5418
	Duodenum and papilla: 16	Duodenum and papilla: 14
	Ampulla: 5	Ampulla: 5
	Distal bile duct: 19	Distal bile duct: 14
Surgical method	PD: 20	PD: 16	0.4072
	PPPD: 31	PPPD: 35
Braun anastomosis	Yes: 5	Yes: 2	0.2400
	No: 46	No: 49
Pancreatic texture	Soft: 27	Soft: 24	0.7918
	Normal or mild fibrosis: 14 Hard: 10	Normal or mild fibrosis: 17 Hard: 10
Pancreatic duct diameter	> 3 mm: 30	> 3 mm: 26	0.4261
	≤ 3 mm: 21	≤ 3 mm: 25
Intraoperative blood transfusion	Yes: 4	Yes: 1	0.3590
	No: 47	No: 50

BMI: Body mass index; PD: Pancreaticoduodenectomy; PPPD: Pylorus-preserving pancreaticoduodenectomy.

Table 5 Comparison of postoperative complications, n

Complication	Single-layer anastomosis group	Double-layer anastomosis group	χ2	P-value
Pancreatic fistula	Yes: 13	Yes: 35	19.0463	0.0000
	No: 38	No: 16
Peritoneal catheterization	Yes: 0	Yes: 6	4.4271	0.0354
	No: 51	No: 45
Abdominal infection	Yes: 1	Yes: 11	9.4444	0.0021
	No: 50	No: 40
Total complications	Yes: 21	Yes: 37	10.2320	0.0014
	No: 30	No: 14

Table 6 Comparison of the incidence of pancreatic fistula in patients with different pancreatic textures in the two groups

Pancreatic texture	Single-layer anastomosis group	Double-layer anastomosis group	χ2	P-value
Soft	10/27	21/24	13.5737	0.0002
Normal or mild fibrosis	2/14	10/17		0.0245
Hard	1/10	4/10		0.3034

Table 7 Comparison of intraoperative and postoperative conditions in the single-layer anastomosis group and the double-layer anastomosis group

Item	Single-layer anastomosis group	Double-layer anastomosis group	Mann-Whitney	P-value
Operation time (min)	220.059 (± 60.602)	379.412 (± 90.761)	179.000	0.000
Pancreaticojejunal anastomosis time (min)	17.922 (± 5.145)	31.333 (± 7.776)	185.000	0.000
Postoperative hospitalization time (d)	18.588 (± 5.285)	26.373 (± 15.815)	854.500	0.003
Total hospitalization time (d)	25.627 (± 6.551)	33.706 (± 15.899)	841.000	0.002
Hospitalization expense (yuan)	116787.667 (± 31900.927)	162788.608 (± 129732.500)	800.000	0.001