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Chirurgie 2. März 2016

Single-layer versus duct-to-mucosa pancreaticojejunostomy in pyloruspreserving pancreatoduodenectomy for ductal adenocarcinoma—an analysis of a single surgeon’s series

Background: Despite considerable efforts there is no consensus regarding the ideal reconstruction method for the pancreatic remnant after pancreaticoduodenectomy (PD).

Methods: Overall, 86 patients who underwent PD for ductal adenocarcinoma were selected for analysis. One surgeon (RF) took responsibility of all pancreatic resections, either by operating personally or proctoring the procedure. The database was prospectively maintained. End-to-side pancreaticojejunostomy (PJ; Group A) was performed from 01/01 to 10/07 and duct-to-mucosa PJ (Group B) from 10/07 to 12/12. Primary endpoints were 30-day mortality, incidence of pancreatic fistulas, and severe complications. Secondary endpoints were severity of pancreatic fistulas, incidence of unplanned reoperation and reintervention and length of stay (LOS).

Results: 30-day mortality, pancreatic fistula, complication, unplanned reoperation and reintervention rates showed no significant differences (2.2 vs. 2.4 %; 6.7 vs. 0 %; 22.2 vs. 29.3 %; 6.7 vs. 0 %; 11.1 vs. 2.2 %). Summarizing unplanned reoperations and reinterventions, the necessity of any unplanned procedure revealed, a significant reduction from 8 (17.8 %) in Group A to 1 (2.2 %) in Group B (p = 0.02). Major complications (Dindo–Clavien Grades III–V) were decreased significantly in Group B (Group A: 9/45 (20 %) vs. Group A: 2/41 (4.9 %); p = 0.05). LOS was significantly shorter in Group B (15 days, +/− 6.01) as compared with Group A (18 days, +/− 8.87; p < 0.05).

Conclusions: Our data show superior outcomes with duct-to-mucosa PJ as compared with single-layer PJ.

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