title: Pancreatic leakage after pancreaticoduodenectomy: the impact of the isolated jejunal loop length and anastomotic technique of the pancreatic stump.
abstract: OBJECTIVE
  To evaluate the impact of the length of the isolated jejunal loop and the type of pancreaticojejunostomy on pancreatic leakage after pancreaticoduodenectomy.
  
  
  METHODS
  One hundred thirty-two consecutive patients who underwent a pancreaticoduodenectomy were studied according to the length of the isolated jejunal loop (short loop, 20-25 cm vs long loop, 40-50 cm) and the type of pancreaticojejunostomy (invagination vs duct to mucosa).
  
  
  RESULTS
  The use of the long isolated jejunal loop was associated with a significantly lower pancreatic leakage rate compared with the use of a short isolated jejunal loop (4.34% vs 14.2%, P < 0.05). In addition, the use of duct-to-mucosa technique was associated with significantly lower incidence of postoperative pancreatic fistula compared with the invagination technique (4.2% vs 14.5%, P < 0.05). Finally, patients with a short isolated jejunal loop compared with patients with a long loop had increased morbidity (50.7% vs 27.5%, P < 0.05) and prolonged hospital stay (16.3 +/- 1.9 days vs 10.2 +/- 2.3 days, P < 0.05). Overall mortality rate was 1.5%.
  
  
  CONCLUSIONS
  The use of a long isolated jejunal loop and a duct-to-mucosa pancreaticojejunostomy is associated with decreased pancreatic leakage rate after pancreaticoduodenectomy.
authors.affiliation: Second Department of Surgery, Aretaieion University Hospital, University of Athens, Greece. foreo@otenet.gr
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Fragulidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vassiliou
authors.forename: Athanasios
authors.initials: A
authors.lastname: Marinis
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.forename: Vaia
authors.initials: V
authors.lastname: Stafyla
authors.forename: Maria
authors.initials: M
authors.lastname: Kyriazi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karapanos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dafnios
authors.forename: Andreas
authors.initials: A
authors.lastname: Polydorou
authors.forename: Dionysios
authors.initials: D
authors.lastname: Voros
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: 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; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010193:Pancreaticojejunostomy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome