Pancreatic leakage after pancreaticoduodenectomy: the impact of the isolated jejunal loop length and anastomotic technique of the pancreatic stump.
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.
Fragulidis
Georgios P
GP
Second Department of Surgery, Aretaieion University Hospital, University of Athens, Greece. foreo@otenet.gr
Arkadopoulos
Nikolaos
N
Vassiliou
Ioannis
I
Marinis
Athanasios
A
Theodosopoulos
Theodosios
T
Stafyla
Vaia
V
Kyriazi
Maria
M
Karapanos
Konstantinos
K
Dafnios
Nikolaos
N
Polydorou
Andreas
A
Voros
Dionysios
D
Smyrniotis
Vassilios
V
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