A new guideline to reduce postoperative morbidity after pancreaticoduodenectomy.
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.
Satoi
Sohei
S
Department of Surgery, Kansai Medical University, Osaka, Japan. satoi@hirakata.kmu.ac.jp
Toyokawa
Hideyoshi
H
Yanagimoto
Hiroaki
H
Yamamoto
Tomohisa
T
Yamao
Jun
J
Kim
Songtae
S
Matsui
Yoichi
Y
Takai
Soichiro
S
Mergental
Hynek
H
Kamiyama
Yasuo
Y
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