A safe and feasible “clock-face” duct-to-mucosa pancreaticojejunostomy with a very low incidence of anastomotic failure: A single center experience of 248 patients

Summary Introduction Postoperative pancreatic fistula (POPF) is one of the most frequent and serious postoperative complications of pancreatoduodenectomy (PD). We sought to assess the impact of a novel pancreaticojejunostomy (PJ) on the rates of POPF and overall postoperative complications. Methods...

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Bibliographic Details
Published in:Journal of visceral surgery 2016-12, Vol.153 (6), p.425-431
Main Authors: Papalampros, A, Niehaus, K, Moris, D, Fard-Aghaie, M, Stavrou, G, Margonis, A.-G, Angelou, A, Oldhafer, K
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Female
Humans
Incidence
Intestinal Mucosa - surgery
Male
Middle Aged
Pancreatic Fistula - epidemiology
Pancreatic Fistula - etiology
Pancreatic Fistula - prevention & control
Pancreaticojejunostomy - methods
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Retrospective Studies
Surgery
Treatment Failure
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Summary:Summary Introduction Postoperative pancreatic fistula (POPF) is one of the most frequent and serious postoperative complications of pancreatoduodenectomy (PD). We sought to assess the impact of a novel pancreaticojejunostomy (PJ) on the rates of POPF and overall postoperative complications. Methods Between 01/2010 and 12/2013, a total of 248 consecutive patients who underwent PD with a modified PJ were identified from our database and retrospectively analyzed. POPF cases were divided into three categories (ISGPF-international study group-guidelines): biochemical fistula without clinical sequelae (grade A), fistula requiring any therapeutic intervention (grade B), and fistula with severe clinical sequelae (grade C). Perioperative outcomes were recorded and analyzed. Results The overwhelming majority of patients had no evidence of fistula. Grade A POPF was observed in 9 (3.62%), grade B in 1 (0.40%), and grade C in 0 patients. There were no postoperative deaths. Overall complications occurred in 61 patients (24.59%) of patients after PD. Conclusions This modified pancreaticojejunostomy is widely applicable and is associated with very low rates of POPF, low postoperative morbidity and mortality. Overall, it is a feasible and safe novel approach with excellent short-term outcomes.
ISSN:1878-7886
1878-7886
DOI:10.1016/j.jviscsurg.2016.05.004