Comparison of different pancreatic anastomosis techniques using the definitions of the International Study Group of Pancreatic Surgery: a single surgeon's experience.
OBJECTIVE
We aimed to compare different techniques using the definitions of the International Study Group of Pancreatic Surgery for postoperative complications after pancreaticoduodenectomy.


METHODS
The perioperative data of 119 patients that underwent pancreaticoduodenectomy by a single surgeon were retrospectively analyzed. Pancreaticojejunal anastomosis was performed using the dunking method (n = 39), the duct-to-mucosa anastomosis method (n = 40), and the duct-to-mucosa adaptation (n = 40).


RESULTS
The most frequent complication was postoperative pancreatic fistula (POPF; grades A, 21%; B, 8%; and C, 3%), postpancreatectomy hemorrhage (PPH; grades B, 7% and C, 1%), and delayed gastric emptying (DGE; grades A, 1% and B, 6%). No significant differences in POPF were found between patients who underwent different types of pancreatic anastomoses. Only pancreatic ductal adenocarcinoma (P = 0.001) and pancreatic texture (P = 0.012) were potentially related to POPF. Patients with or without POPF grade A had shorter postoperative stays than patients with grade B or C POPF (P < 0.001), and similar findings were obtained for DGE and PPH.


CONCLUSIONS
The successful management of pancreatic anastomoses depends more on a meticulous surgical technique and appropriate experience rather than on the type of technique. Furthermore, the International Study Group of Pancreatic Surgery definitions of POPF, DGE, and PPH seem objective and universally acceptable.
You
DongDo
D
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jung
KyungUk
K
Lee
HyungGeun
H
Heo
JinSeok
J
Choi
SeongHo
S
Choi
DongWook
D
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007391:International Cooperation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology