Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial.
BACKGROUND
Anastomotic failure is still a significant problem that affects the outcome of pancreaticoduodenectomy. There have been many techniques proposed for the reconstruction of pancreatic digestive continuity, but there have been few prospective and randomized studies that compare their efficacy.


METHODS
In the current work, 144 patients who underwent a pancreaticoduodenectomy with soft residual tissue were assigned randomly to receive either a duct-to-mucosa anastomosis (group A) or a 1-layer end-to-side pancreaticojejunostomy (group B).


RESULTS
The 2 treatment groups were found not to have any differences in regards to vital statistics, underlying disease, or operative techniques. The postoperative course was complicated in 54% of the 144 patients, with a comprehensive incidence of abdominal complications in 36% (group A, 35%; group B, 38%; P=not significant). The principal complication was pancreatic fistulas, which occurred in 14% of patients (group A, 13%; group B, 15%; P=not significant). Two patients (2%) required reoperation; the postoperative mortality rate was 1%.


CONCLUSIONS
The 2 methods that were studied revealed no significant difference the rate of complications.
Bassi
Claudio
C
Surgical and Gastroenterological Department, Endocrine and Pancreatic Unit, Hospital G.B. Rossi University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy.
Falconi
Massimo
M
Molinari
Enrico
E
Mantovani
William
W
Butturini
Giovanni
G
Gumbs
Andrew A
AA
Salvia
Roberto
R
Pederzoli
Paolo
P
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies