Early postoperative outcomes of dunking pancreatojejunostomy

Abstract

Background: There is no gold standard method for pancreatico-enteric reconstruction. In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice. In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out 75 (6.6%) developed Grade ‘B’ POPF and three out 75 (3.3%) developed Grade ‘C’ POPF. 20 out 75 (26.6%) had grade ‘A’ DGE, five out of 75(6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (invagination) pancreatojejunostomy has acceptable early outcomes with clinically significant/relevant postoperative pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage rates of 10.4% (grade B and C), 33.2% and 5.3% respectively. The outcomes are comparable with those of Duct-to-Mucosa PJ mentioned in literature.