Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study  

作　　者：Yi Sun Xiao-Feng Yu Han Yao Shi Xu Yu-Qiao Ma Chen Chai 

机构地区：[1]Department of General Surgery,The People’s Hospital of Suzhou New District,Suzhou 215000,Jiangsu Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2023年第9期1901-1909,共9页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by Clinical Medical Science and Technology Development Foundation of Jiangsu University,No.JLY2021118;Science and Technology Project of Suzhou City,No.SKJY2021039.

摘　　要：BACKGROUND Pancreatoduodenectomy(PD)is the most effective surgical procedure to remove a pancreatic tumor,but the prevalent postoperative complications,including postoperative pancreatic fistula(POPF),can be life-threatening.Thus far,there is no consensus about the prevention of POPF.AIM To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy(PJ)on POPF development.METHODS We retrospectively collected and analyzed the data of 215 patients who under-went PD between January 2017 and February 2022 in our surgery center.The risk factors for POPF were analyzed by univariate analysis and multivariate logistic regression analysis.Then,we stratified patients by anastomotic technique(end-to-side invagination PJ vs modified duct-to-mucosa PJ)to conduct a comparative study.RESULTS A total of 108 patients received traditional end-to-side invagination PJ,and 107 received modified duct-to-mucosa PJ.Overall,58.6%of patients had various complications,and 0.9%of patients died after PD.Univariate and multivariate logistic regression analyses showed that anastomotic approaches,main pancreatic duct(MPD)diameter and pancreatic texture were significantly associated with the incidence of POPF.Additionally,the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2%and 283.4 min,respectively,which were significantly lower than those in patients receiving traditional end-to-side invagination PJ(27.8%and 333.2 minutes).CONCLUSION Anastomotic approach,MPD diameter and pancreatic texture are major risk factors for POPF development.Compared with traditional end-to-side invagination PJ,modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF.Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.

关 键 词：PANCREATICOJEJUNOSTOMY PANCREATODUODENECTOMY Suture technique Pancreatic fistula 

分 类 号：R735.0[医药卫生—肿瘤]