Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy

Abstract

BACKGROUND As one of the major abdominal operations, pancreaticoduodenectomy (PD) involves many organs. The operation is complex, and the scope of the operation is large, which can cause significant trauma in patients. The operation has a high rate of complications. Pancreatic leakage is the main complication after PD. When pancreatic leakage occurs after PD, it can often lead to abdominal bleeding and infection, threatening the lives of patients. One study found that pancreatic leakage was affected by many factors including the choice of pancreaticojejunostomy method which can be well controlled. AIM To investigate the choice of operative methods for pancreaticojejunostomy and to conduct a multivariate study of pancreatic leakage in PD. METHODS A total of 420 patients undergoing PD in our hospital from January 2014 to March 2019 were enrolled and divided into group A ( n = 198) and group B ( n = 222) according to the pancreatointestinal anastomosis method adopted during the operation. Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B. The operation time, intraoperative blood loss, and pancreatic leakage of the two groups were assessed. The occurrence of pancreatic leakage after the operation in different patients was analyzed. RESULTS The differences in operative time and intraoperative bleeding between groups A and B were not significant ( P > 0.05). In group A, the time of pancreatojejunostomy was 26.03 ± 4.40 min and pancreatic duct diameter was 3.90 ± 1.10 mm. These measurements were significantly higher than those in group B ( P < 0.05). The differences in the occurrence of pancreatic leakage, abdominal infection, abdominal hemorrhage and gastric retention between group A and group B were not significant ( P > 0.05). The rates of pancreatic leakage in patients with preoperative albumin < 30 g/L, preoperative jaundice time ≥ 8 wk, and pancreatic duct diameter < 3 mm, were 23.33%, 33.96%, and 19.01%, respectively. These were significantly higher than those in patients with preoperative albumin ≥ 30 g/L, preoperative jaundice time < 8 wk, and pancreatic duct diameter ≥ 3 cm ( P < 0.05). Logistic regression analysis showed that preoperative albumin < 30 g/L, preoperative jaundice time ≥ 8 wk, and pancreatic duct diameter < 3 mm were risk factors for pancreatic leakage after PD (odds ratio = 2.038, 2.416 and 2.670, P < 0.05). CONCLUSION The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage. The main risk factors for pancreatic leakage include preoperative albumin, preoperative jaundice time, and pancreatic duct diameter.

Efficacy of the omental roll-up technique in pancreaticojejunostomy to prevent postoperative pancreatic fistula after pancreaticoduodenectomy

“…Various surgical and inherent factors are considered responsible for the leak. A non-dilated PD, soft texture of the pancreas, high blood loss, and poor nutritional status of the patient are a few of the factors influencing healing [12].…”

Comparison of two anastomosis techniques in terms of postoperative pancreatic fistula development: A retrospective cohort study

“…In Group TLPJ, the jejunal serosa and pancreatic capsule were sutured intermittently with 4/0 polydioxanone (PDS) without resection of the serosa, and duct-to-mucosa anastomosis was performed with 4/0 PDS [8]. Conversely, in Group MLLPJ, a segment of the jejunal serosa smaller than the surface of the pancreas was excised using a scalpel, allowing the pancreas to invaginate into the small intestine, with surgeons taking care not to open the mucosa.…”

“…Narrow pancreatic duct (<3 mm) and soft pancreatic tissue, which are among the risk factors for the development of POPF, have been studied extensively [5,6]. It has been speculated that technical modifications, including external stenting of the pancreatic duct, pancreatico-jejunal or pancreatico-gastric anastomosis, and reinforcement of the anastomosis via several materials, might reduce POPF rates compared to the use of only two-layer end-to-side duct-tomucosal pancreaticojejunostomy (TLPJ) [7,8]. Nevertheless, the use of techniques or modifications, such as the Blumgart method with one to six transpancreatic jejunal seromuscular U-sutures, modified Kakita anastomosis with two to eight nonabsorbable interrupted penetrating sutures between the pancreatic stump and jejunal seromuscular layer, two-layer duct-to-mucosa anastomosis with resection of jejunal serosa (layer-to-layer PJ), and modified layer-to-layer PJ (MLLPJ), resulted in controversial outcomes [7,[9][10][11][12][13][14].…”

A super-selective coil impregnation therapy for pancreatic duct haemorrhage caused by pseudoaneurysm rupture

“…The surgery is complex, the surgical scope is large, the trauma to patients is also significant, and the risk of postoperative complications is high. Furthermore, the complications such as pancreatic leakage may often lead to abdominal bleeding or infection, or even lead to life-threatening conditions [ 2 ]. Interventional embolization is a minimally invasive surgery, which causes less trauma to the patients and offers a quick recovery after surgery.…”