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. 2023 Sep 27;15(9):1901-1909.
doi: 10.4240/wjgs.v15.i9.1901.

Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study

Yi Sun  1 , Xiao-Feng Yu  1 , Han Yao  1 , Shi Xu  1 , Yu-Qiao Ma  1 , Chen Chai  2
Affiliations

Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study

Yi Sun et al. World J Gastrointest Surg. .

Abstract

Background: Pancreatoduodenectomy (PD) is the most effective surgical procedure to remove a pancreatic tumor, but the prevalent postoperative complications, including postoperative pancreatic fistula (POPF), can be life-threatening. Thus far, there is no consensus about the prevention of POPF.

Aim: To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy (PJ) on POPF development.

Methods: We retrospectively collected and analyzed the data of 215 patients who underwent PD between January 2017 and February 2022 in our surgery center. The risk factors for POPF were analyzed by univariate analysis and multivariate logistic regression analysis. Then, we stratified patients by anastomotic technique (end-to-side invagination PJ vs modified duct-to-mucosa PJ) to conduct a comparative study.

Results: A total of 108 patients received traditional end-to-side invagination PJ, and 107 received modified duct-to-mucosa PJ. Overall, 58.6% of patients had various complications, and 0.9% of patients died after PD. Univariate and multivariate logistic regression analyses showed that anastomotic approaches, main pancreatic duct (MPD) diameter and pancreatic texture were significantly associated with the incidence of POPF. Additionally, the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2% and 283.4 min, respectively, which were significantly lower than those in patients receiving traditional end-to-side invagination PJ (27.8% and 333.2 minutes).

Conclusion: Anastomotic approach, MPD diameter and pancreatic texture are major risk factors for POPF development. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF. Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.

Keywords: Pancreatic fistula; Pancreaticojejunostomy; Pancreatoduodenectomy; Suture technique.

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Conflict of interest statement

Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.

Figures

Figure 1
Figure 1
Schematic diagram of end-to-side invagination pancreaticojejunostomy. A: Continuous suturing was performed between the rear side of the pancreatic stump (approximately 1.5 cm from its edge) and the jejunal seromuscular layer with a 3-0 Prolene slip line; B: Suture of the pancreatic margin and seromuscular layer of the jejunum intermittently; C: The pancreatic stump was inserted into the jejunum, and the anterior side of the pancreas and jejunal seromuscular layer were continuously sutured.
Figure 2
Figure 2
Schematic diagram of modified duct-to-mucosa pancreaticojejunostomy. A: Perform continuous suturing between the rear edge of the pancreatic stump and jejunal seromuscular layer with a 3-0 Prolene suture; B: Sew 3-4 stiches continuously in the posterior wall of the pancreatic duct and the jejunal mucosa with 4-0 Prolene sutures; C: Continuous suturing was performed between the front edge of the pancreatic stump and the whole layer of the jejunum.
See this image and copyright information in PMC

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