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Journal of Gastrointestinal Surgery

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01-11-2019 | Pancreaticojejunostomy | Original Article

The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas

Authors: Lisbi Rivas, Sara L. Zettervall, Tammy Ju, Samantha Olafson, Jeremy Holzmacher, Paul P. Lin, Khashayar Vaziri

Published in: Journal of Gastrointestinal Surgery | Issue 11/2019

Abstract

Introduction

A soft pancreas has been associated with an increased risk of post-operative pancreatic fistula formation. Few studies have evaluated the effect of anastomotic technique (duct to mucosa vs invagination) on fistula formation. This study aims to compare the effect of anastomotic technique on fistula formation among patients with a soft pancreas in a large multiinstitutional database.

Methods

The targeted pancreas module of the American College of Surgeons–National Surgical Quality Improvement Program (NSQIP) Database was used. All patients with a soft pancreas who underwent pancreaticoduodenectomy from 2014 to 2015 were identified. Demographic data, comorbid conditions, operative variables, and 30-day outcomes were compared using univariate and multivariable analyses.

Results

A total of 975 patients met inclusion criteria. Eight-hundred fifty four (88%) underwent a duct to mucosa pancreaticojejunostomy technique and 121 (12%) underwent invagination. Patients who underwent invagination had higher 30-day mortality (5.8% vs 1.4%, p < 0.01), higher fistula formation (38% vs 25%, p < 0.01), and more often had percutaneous drain placement post-operatively (27% vs 14%, p < 0.01). Following multivariable analysis, invagination remained associated with pancreatic fistula formation (OR 2.5, CI 1.4–4.3) and post-operative percutaneous drain placement (OR 1.8, CI 1.1–2.9).

Conclusion

Invagination technique for pancreaticojejunostomy in patients with a soft pancreas is associated with increased rates of pancreatic fistula. Surgeons should consider utilizing a duct to mucosa technique when feasible to decrease morbidity following pancreaticoduodenectomy in this patient population.

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Title: The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas
Authors: Lisbi Rivas
Sara L. Zettervall
Tammy Ju
Samantha Olafson
Jeremy Holzmacher
Paul P. Lin
Khashayar Vaziri
Publication date: 01-11-2019
Publisher: Springer US
Keywords: Pancreaticojejunostomy
Invagination
Published in: Journal of Gastrointestinal Surgery / Issue 11/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04164-6

At a glance: The STEP trials

Springer Medicine

The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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