title: Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study.
abstract: OBJECTIVE
  This study's aim is to evaluate the effectiveness of using an internal stent when fashioning a duct-to-mucosa pancreatojejunostomy on preventing pancreatic fistula formation, as well as on the overall outcome for patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  Between January 2000 and December 2008, 82 consecutive patients underwent pancreaticoduodenectomy and duct-to-mucosa pancreaticojejunostomy in an isolated jejunal loop, either with or without the aid of an internal stent. The allocation of the patients into group A (n = 41, stented anastomosis) and group B (n = 1, unstented anastomosis) was performed in a strictly alternating way. No statistically significant differences were identified between the two groups regarding age, sex, operative time, intraoperative pathological findings, and comorbidities. The two groups were compared regarding the rate of pancreatic fistula formation, postoperative complications, and hospital stay.
  
  
  RESULTS
  In group A, pancreatic fistula formation rate was 4.9%; overall morbidity reached 30%; and hospital stay duration was 13 +/-4 days. In group B, pancreatic fistula formation rate was 2.4%; overall morbidity was 26%; and hospital stay duration extended to 14 +/- 5. According to Clavien's classification, the severity of surgical complications was designated as follows: for group A, 56% of the complications were allocated as grade I, 38% grade II, 4% grade III, 2.5% grade IV, and 0% grade V. The relative values for group B were 53%, 42%, 3%, 2%, and 0%, respectively. In six group A patients (14.7%), the internal stent was found stuck in the pancreatic stump, causing severe back pain requiring analgesic treatment with opioids for four of them. In group B, four patients (9.7%) complained of mild back pain, none of which required regular treatment. No mortalities were recorded in both groups. No statistically significant differences were found between the two groups regarding fistula formation and severity of complications.
  
  
  CONCLUSIONS
  Internal stenting of a duct-to-mucosa pancreatojejunostomy does not diminish the rate of pancreatic fistula formation or alter overall patient's outcome.
authors.affiliation: 5th Department of Surgery, Areteion Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Maria A
authors.initials: MA
authors.lastname: Kyriazi
authors.forename: Michael
authors.initials: M
authors.lastname: Derpapas
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.forename: Constantinos
authors.initials: C
authors.lastname: Gennatas
authors.forename: Agathi
authors.initials: A
authors.lastname: Kondi-Paphiti
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vassiliou
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000295:instrumentation; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome