A personal technical experience and results of a modified end-to-side technique of pancreatojejunostomy: A 350 patients retrospective cohort study.

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A personal technical experience and results of a modified end-to-side technique of pancreatojejunostomy: A 350 patients retrospective cohort study.

Eur J Surg Oncol. 2018 Nov 10;:

Authors: Liu H, He A, Liu K, Jiang Z, Zhang F, Li X, He Y, Tao K, Wang L, Yue S

Abstract
BACKGROUND: In pancreatoduodenectomy，the treatment of pancreatic stump is a critical step, pancreaticoduodenectasis and hemorrhage are the two most common complications, which are closely related to the operation of pancreaticojejunostomy and because leaks from this incur major morbidity and mortality. We describe the special technical experience of a modified end-to-side pancreatojejunostomy(mPJ): surgical methods which combine jejunal decompression tube with pancreatic duct jejunal parachute monolayer suture，and report on the outcome of the consecutive 350 patients.
METHOD: From December 2009 to December 2016, 350 pancreatic resections were performed by a single surgeon which are consecutive. Data were retrieved from a prospectively collected Institutional database, and used for the present retrospective evaluation. Post-operative pancreatic fistulas (POPF) were stratified with the Fistula Risk Score (FRS), based on the 2005-International Study Group of Pancreatic Fistula classification (ISGPFc) and on the subsequent 2016-revised version (ISGPSc).
RESULTS: ISGPFc POPF occurred in 67/350 (19.14%): grade A in 48/350 (13.71%), grade B in 16/350 (4.57%) and grade C in 3/350 (0.86%). On the ISGPSc, POPF rate averaged 5.43%: grade B in 16/350 (4.57%) and grade C in 3/350 (0.86%). POPF rate associated with high FRS was 22.6%/9.7% (ISGPFc/ISGPSc). With low and intermediate FRS, POPFs were 5.3%/1.3% (ISGPFc/ISGPSc) and 25.7%/6.9% (ISGPFc/ISGPSc) respectively. Re-operation rate was 0.86%. In-hospital mortality rate was 0.86% and specific mortality rate for POPF was 0.86%.
CONCLUSIONS: The mPJ technique is associated with a POPF rate which was less than expected, especially for "difficult" pancreas with high FRS (soft gland texture and small duct). A larger prospective series is needed in addition to comparative studies with other techniques for robust assessment.

PMID: 30470530 [PubMed - as supplied by publisher]

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