title: A new guideline to reduce postoperative morbidity after pancreaticoduodenectomy.
abstract: OBJECTIVE
  Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in perioperative managements of pancreaticoduodenectomy.
  
  
  METHODS
  Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In June 2004, the following new departmental guidelines were introduced: (1) modified Kakita method of pancreaticojejunostomy, (2) omental wrapping, (3) early removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were determined.
  
  
  RESULTS
  Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = 0.019). Occurrence of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P = 0.0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = 0.0133). Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed gastric emptying.
  
  
  CONCLUSIONS
  The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been reduced because of the introduction of a new guideline.
authors.affiliation: Department of Surgery, Kansai Medical University, Osaka, Japan. satoi@hirakata.kmu.ac.jp
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Jun
authors.initials: J
authors.lastname: Yamao
authors.forename: Songtae
authors.initials: S
authors.lastname: Kim
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Soichiro
authors.initials: S
authors.lastname: Takai
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kamiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors