Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Abstract Background:Pancreaticoduodenectomy remains the gold standard for management of patients with pancreatic head and periampullary neoplasms. Despite the low mortality, overall morbidity remains high, principally due to the development of a clinically relevant postoperative pancreatic fistula (CR-POPF).The aim of the present study is to compare rates of CR-POPF in two groups of patients treated with two different pancreaticojejunostomy techniques. Methods:Among 264 consecutive patients submitted to surgery for pancreatic neoplasm, 142 pancreaticoduodenectomies with end-to-side pancreaticojejunostomy were analysed. The first group of patients underwent a direct mucosa-to-mucosa anastomosis as described by Longmire and Traverso. In the second group, a duct-to-mucosa anastomosis with an outer seromuscolar and inner full thickness layer as described by Z’graggen, Shrikhande and Buchler was performed. Results: Mortality was 2,8% in the first group (2/71) and zero in the second. In group 1°, 48.5% of patients suffered one or more grade II-V Clavien-Dindo complications; in group 2°, complications were observed in 26,7% of patients. Clinically relevant POPF occurred in 12 patients in group 1° (17%) and in 4 patients in group 2° (5,6%). Conclusions: Changing pancreaticojejunostomy techniques may produce different outcomes. In our experience, a standardized duct-to-mucosa anastomosis, as performed in group 2, significantly reduced the rate of CR-POPF.