One layer pancreaticojejunostomy using reinforcing suture in pancreaticoduodenectomy

Introduction: Postoperative pancreatic fistula (POPF) is a critical complication after pancreaticoduodenectomy (PD). Accordingly, discussions about pancreaticojejunostomy (PJ), which can reduce the incidence of POPF, are ongoing. Here, we introduce the surgical technique of PJ performed at our hospital and analyze its safety and advantages. Methods: We retrospectively analyzed 122 patients who underwent one-layer PJ using reinforcing sutures among 125 patients who underwent PD at Hanyang University Hospital between August 2007 and December 2017. PJ was performed with reinforcing sutures of the pancreatic stump, including the insertion of a soft silastic catheter for internal drainage followed by suturing of the pancreas and jejunum with one layer. We followed the 2016 International Study Group for postoperative Pancreatic Fistula definition and severity grading. Results: Of the 122 patients who underwent PJ with this technique, 62 patients (50.8%) developed POPF. Thirty seven patients (30.3%) had grade A (mild) POPF that did not affect hospital course. Critical POPF occurred in 25 patients, grade B in 20 (16.4%) and grade C in 5 (4.1%). Factors affecting POPF occurrence were body weight (p = 0.005), body mass index (p = 0.002), American Society of Anesthesiologists score (p = 0.031), and pancreas-related diagnosis (p = 0.019). Finally, when performed with this technique, although POPF was significantly lower in pancreas-related diseases (p = 0.019), there was no significant difference in the occurrence of POPF with critical problems between two groups (p = 0.630). Conclusions: Although this techinque cannot prevent POPF, we noted no significant difference in postoperative complications including POPF versus other surgical techniques reported before. In addition, this technique, which was designed to increase pancreatic texture, is practical and simple for PJ. Therefore, the inexperienced hepatobiliary and pancreatic surgeon may perform it without major complications.Docto