Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial

Abstract

Objective: This study compared the postoperative pancreatic anastomosis leakage rate of a new binding technique with the conventional technique of pancreaticojejunostomy after pancreaticoduodenectomy.

Summary background data: Leakage from pancreatic anastomoses remains the single most important morbidity after pancreaticoduodenectomy and contributes to prolonged hospitalization and mortality. The reported incidence after conventional pancreaticojejunostomy ranged from 10% to 29%. We previously reported a new binding pancreaticojejunostomy technique with a leakage of 0%.

Methods: We conducted a prospective randomized study on 217 patients who underwent pancreaticoduodenectomy for benign and malignant diseases of the pancreatic head and the periampullary region comparing the 2 techniques of pancreaticojejunostomy.

Results: Of the 111 patients randomized to the conventional group, pancreaticojejunostomy leakage occurred in 8 patients, while no patient in the 106 patients randomized to the binding group developed leakage (chi test, P = 0.014). The overall postoperative complications developed in 41 patients (36.9%) in the conventional group compared with 26 patients (24.5%) in the binding group (chi test, P = 0.048). Seven patients (6.3%) died in the perioperative period in the conventional group compared with 3 patients (2.8%) in the binding group (chi test, P = 0.37). The postoperative hospital stay (mean +/- SD) for the conventional group was 22.4 +/- 10.9 days, which was significantly longer than the binding group (18.4 +/- 4.7 days) (Mann-Whitney U test, P < 0.001).

Conclusions: Binding pancreaticojejunostomy after panceaticoduodenectomy significantly decreased postoperative complication and pancreaticojejunostomy leakage rates and shortened hospital stay when compared with conventional pancreaticojejunostomy.

Figures

FIGURE 1. Flow chart.

FIGURE 2. A, Pancreatic stump isolated for >3 cm. End of jejunum everted for 3 cm. Everted jejunal mucosa destroyed with carbolic acid. B, The 2 sutures for everting the jejunum were cut and the everted jejunum was restored to its normal position to wrap over the pancreatic stump. The gap between the jejunum and the pancreatic stump is sealed by compressing from the outside with a binding ligature. C, The binding ligature is the real anastomotic site. Tip of a clamp can pass underneath the binding ligature. D, Injection of saline dyed with methylene blue into jejunal lumen to confirm watertight closure of the anastomosis.