Abstracts
1997 Digestive Disease Week

Stented pancreatico-jejunostomy end-to-side versus end-to-end pancreatico-jejunal invagination: a prospective observation study.

JD Roder, G Schmidmaier, P Vorwald, HJ Stein, JR Siewert. Department of Surgery, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen, Germany.

Introduction: Leakage of the pancreatico-jejunal anastomosis is a leading cause of postoperative morbidity and mortality after partial pancreatoduodenectomy. In a prospective observation study we compared a stented pancreaticojejunostomy (duct to mucosa) to a non stented end-to-end pancreatojejunal invagination anastomosis.

Patients and Methods: Between Nov 1994 and Nov 1996 a total of 56 patients had a partial pancretoduodenectomy with pancreato-jejunal anastomosis at our institution. Of these, 30 patients had a non stented end-to-end pancreato-jejunal invagination anastomosis (group A), 26 had a pancreaticojejunostomy (duct to mucosa) end-to-side (group B). All anastomoses were performed in a two layer technique and drained with a closed suction system. Pancreatic fistula was defined as drainage of more than 50 cc amylase rich fluid. The choice of the type of the anastomosis was up to the discretion of the surgeon performing the procedure. There were no significant differences between both patient groups with respect to age, sex, preoperative blood chemistry, tumor type and stage, operative time, intraoperative blood loss, pancreatic texture, length of the pancreatic remnant and pancreatic duct diameter.

Results: Postoperative mortality was 6.7% (2/30) in group A and 0% (0/26) in group B. Postoperative morbidity was significantly higher in group A (20/30 patients, 67%) as compared to group B (8/26 patients, 30.8%, p<0.05). A pancreatic fistula was observed in 10/30 (33.3%) patients of group A as compared to 3/26 (11.5%) patients in group B (p<0.05). This resulted in a significantly longer hospital stay in patients of group A (group A :30.9±8 days, group B: 18.2±7 days, p<0.05).

Conclusions: In partial pancreatoduodenectomy a stented end-to-side (duct to mucosa) pancreaticojejunostomy is a safer anastomotic technique of the pancreatic remnant than an end-to-end pancreatico-jejunal invagination resulting in less morbidity, fewer pancreatic fistulas and a shorter hospital stay.