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

Abstract

Background/Aim: Postoperative pancreatic fistula (POPF) development is a common complication after pancreaticoduodenectomy. Various surgical anastomosis techniques have been proposed to mitigate this risk. This study compares two techniques: the two-layer duct-to-mucosa pancreaticojejunostomy (TLPJ) and the modified layer-to-layer end-to-side duct-to-mucosa pancreaticojejunostomy with jejunal serosa resection (MLLPJ). Methods: A retrospective cohort study was conducted on patients who underwent pancreaticoduodenectomy between January 2012 and December 2020. The primary outcome was the rate of biochemical leak and clinically relevant POPF (grades B and C POPFs). Results: The rate of biochemical leak was significantly higher in the TLPJ group than in the MLLPJ group (54.5% vs. 4.0%, P<0.001). Clinically relevant POPFs developed in 5.2% of all patients, with rates of 6.1% in the TLPJ group and 4.0% in the MLLPJ group. Patients with longer surgery durations, increased bleeding, and a soft pancreas texture had significantly higher risk of developing clinically relevant POPFs (P=0.009, P=0.039, and P=0.022, respectively). Conclusion: The MLLPJ anastomosis technique demonstrated a significant reduction in biochemical leak rates. However, the choice between TLPJ and MLLPJ did not significantly impact the rates of clinically relevant POPFs. Other factors, such as surgery duration, bleeding volume, and pancreas texture, were identified as significant risk factors for the development of these fistulas.