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.
