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Modified One-layer Duct-to-mucosa Pancreaticojejunostomy Reduces Pancreatic Fistula after Pancreaticoduodenectomy



Published on:2016-11-28   Views:185

Abstract

Postoperative pancreatic fistula (POPF) isa major source of morbidity after pancreaticoduodenectomy (PD). The purpose ofthis retrospective study comparing one-layer pancreaticojejunostomy (PJ) withtwo-layer PJ after PD was to evaluate whether the one-layer duct-to-mucosa PJafter PD can reduce the incidence of POPF.A total of 194 consecutive patientswho underwent PD by one surgeon (Y. Miao) from January 2011 to February 2014were included in this study. Among those patients, 104 underwent one-layer PJ(one-layer group) and 90 patients underwent two-layer PJ (two-layer group),respectively. Preoperative clinicopathologic features, intraoperativeparameters, postoperative morbidity with focus on POPF, were compared betweenthe two groups.The overall incidence of POPF was 19.6% (38/194), and clinicallyrelevant grade B/C POPF rates were 8.6% (16/194) and 3.1% (6/194),respectively. There were no differences in patients' demographics and operationrelated factors between the two groups. However, the incidence of POPF in theone-layer group was significantly lower than in two-layer group (13.5% [14/104patients] and 26.7% [24/90 patients] respectively; p=0.021). The medianpostoperative hospital stay was also significantly lower in the one-layer groupcompared to the two-layer group (13 days vs. 15 days, p=0.035). One patient intwo-layer group died due to postoperative hemorrhage.One-layer duct-to-mucosapancreaticojejunostomy is a simple and easy technique for pancreaticojejunalanastomosis after PD, and can reduce the POPF rate in comparison to thetwo-layer technique.