Novel Pancreaticojejunostomy with a Low Rate of Anastomotic Failure-Related Complications

• Published in: Journal of the American College of Surgeons Vol. 210; no. 1; pp. 54 - 59
• Main Authors: Grobmyer, Stephen R., MD, FACS, Kooby, David, MD, FACS, Blumgart, Leslie H., MD, FACS, Hochwald, Steven N., MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2010; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Biological and medical sciences; Epidemiology; General aspects; Humans; Incidence; Length of Stay; Medical sciences; Middle Aged; Pancreatic Neoplasms - surgery; Pancreaticojejunostomy - methods; Pancreaticojejunostomy - mortality; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Surgery; Survival Rate; Suture Techniques; Treatment Outcome; Medicine; Risk rate; Treatment; Surgery; Complication; Epidemiology; Failure
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2009.09.020

Background Pancreatic anastomotic failure has traditionally been a source of significant morbidity and potential mortality after pancreaticoduodenectomy. Both patient-derived and technical factors contribute to pancreatic anastomotic failure. From a technical standpoint, an “ideal” pancreaticojejunal anastomosis would meet the following criteria: applicable to all patients, easy to teach, and associated with a low rate of pancreatic anastomotic failure-related complications. The pancreaticojejunostomy described by one of the authors (LHB) meets the criteria for an “ideal” pancreaticojejunostomy. Study Design We performed an audit of results of a consecutive series of patients at two institutions who underwent pancreaticojejunostomy using the described technique. Pancreaticojejunostomy after pancreaticoduodenectomy was performed in all cases using a novel two-layer technique consisting of an outer full thickness pancreas-to-seromuscular jejunal anastomosis and an inner duct-to-mucosal anastomosis. Incidences of pancreatic anastomotic failure (measured using the International Study Group of Pancreatic Fistula definition) and perioperative pancreatic anastomotic failure-related complications were analyzed. Results One hundred eighty-seven patients underwent pancreaticojejunostomy after pancreaticoduodenectomy using the described technique. Overall mortality was 1.6%. The rate of clinically significant pancreatic anastomotic failure (International Study Group of Pancreatic Fistula grade B or C) was only 6.9%. There was no bleeding, reoperation, or mortality secondary to pancreatic anastomotic failure among patients in this series. Conclusions The novel pancreaticojejunostomy is applicable to all patients in whom the pancreatic duct can be identified, and it is associated with very low rates of significant postoperative morbidity and mortality. These findings support its routine use for pancreaticojejunal reconstruction after pancreaticoduodenectomy.