Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):84-90. 10.14701/ahbps.21-054.

What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

• Lee KF
• Cheung Wong KK
• Juen Lo EY
• Cheung Kung JW
• Lok HT
• Ning Chong CC
• Wong J
• San Lai PB
• Chai Ng KK

• KMID: 2526836
• DOI: http://doi.org/10.14701/ahbps.21-054

Abstract

Backgrounds/Aims
Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ.
Methods
A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ.
Results
Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027).
Conclusions
DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.

Keyword

Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreatic fistula

Figure

• 

  Fig. 1 A Schematic drawing of the modified Blumgart’s technique. (A) Posterior layer of the outer transpancreatic U-sutures were placed. (B) Posterior layer of duct-to-mucosa interrupted stitches were tied after the U-sutures were tightened, anterior row of duct-to-mucosa stitches were inserted. (C) After the anterior row of duct-to-mucosa were tightened and tied, the anterior row of the outer U-suture were made. (D) Completed anastomosis after the U-sutures were tied.

• 

  Fig. 2 The relationship between pancreatic duct size and clinical significant pancreatic fistula. *Statistically significant (p < 0.05).

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