Is a nonstented duct-to-mucosa anastomosis using the modified Kakita method a safe procedure?
OBJECTIVE
After standardization of the perioperative management of pancreaticoduodenectomy, we retrospectively compared results in nonstented pancreaticojejunostomy with external-stented pancreaticojejunostomy.


METHODS
The study population included 129 consecutive patients who underwent pancreaticoduodenectomy between 2004 and 2008. The postoperative mortality and morbidity were compared between 51 patients with restrictive use of external stenting (group A) and 78 patients without external stenting (group B). The patient with a pancreatic duct of less than 3 mm in diameter was 31% in group A and 46% in group B.


RESULTS
There were no differences in postoperative morbidity and mortality between the 2 groups. Although the frequency of overall postoperative pancreatic fistula development was significantly higher in group B than in group A (44% vs 27%, P = 0.0004), there was no difference in grade B/C postoperative pancreatic fistula rate (group A: 5.9% vs group B: 14.1%). The length of in-hospital stay in group B was significantly shorter than group A (13 vs 24 days, P < 0.0001). There were no differences in postoperative morbidity and mortality between subgroups that were consisted of patients with small pancreatic duct diameter.


CONCLUSIONS
This retrospective single-center study showed that nonstented duct-to-mucosa anastomosis was a safe procedure and was associated with a shortened in-hospital stay.
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
Hirooka
Satoshi
S
Yui
Rintaro
R
Yamaki
So
S
Takahashi
Kanji
K
Matsui
Yoichi
Y
Mergental
Hynek
H
Kwon
A-Hon
AH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004322:Drainage; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome