Background: Pancreaticoduodenectomy (PD) is a routine method in pancreatic surgery. To date, postoperative pancreatic fistula (POPF) remains the most common complication and is also the major cause to death after pancreaticoduodenectomy. In order to reduce the incidence of POPF, we established a new anastomosis technique where we use a half purse-string suture on the basis of two-layer duct-to-mucosa pancreaticojejunostomy (PJ) technique and also assessed the effectiveness and safety of this approach in this study.
Methods: To evaluate this new approach, 80 patients who received the new PJ technique were included in this study during 2017–2018. Meanwhile, 195 patients who underwent traditional duct-to-mucosa PJ were collected. We also introduced this new surgical approach in detail and analyzed various risk factors for postoperative complications to verify its safety and advantages.
Results: First of all, there were no significant differences in patients' preoperative characteristics. Besides, patients in the new PJ group received a less operative time (175.2±45.8 vs. 161.3±41.0, p=0.022) while no differences were found in blood loss, length of hospital stay and cost. The incidence of POPF in the new PJ group was 19%, which was much lower than those in the traditional PJ group (36%) (p=0.007). More importantly, a much lower incidence of grades B POPF (14% vs. 4%, p=0.026) was found in the new technology group, which would clinically benefit patients a lot. Univariate and multivariate regression analysis also verified that this new PJ procedure was effective to improve postoperative POPF.
Conclusions: Results demonstrate that this new technique is easy accomplished, safe and effective compared to traditional approach, which showed satisfactory outcomes especially at resulting in a lower POPF incidence.