Binding versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: a case-matched study.
BACKGROUND
Postoperative morbidity of pancreaticoduodenectomy remains high and is mainly related to postoperative pancreatic fistula. Peng et al. (J Gastrointest Surg 2003;7:898-900; Am J Surg 2002;183:283-285; Ann Surg 2007;245:692-298) recently described binding pancreaticojejunostomy and reported a zero percent rate of pancreatic fistula. The aim of this study was to compare postoperative outcome of binding pancreaticojejunostomy and conventional pancreaticojejunostomy after pancreaticoduodenectomy.


METHODS
Between June 2006 and June 2008, a case-control study was conducted, including all patients with binding pancreaticojejunostomy after pancreaticoduodenectomy. These patients were matched with similar patients with conventional pancreaticojejunostomy. Matching criteria were as follows: age, body mass index, pancreatic texture, and pancreatic main duct size. Postoperative mortality and morbidity were analyzed. Postoperative pancreatic fistula was defined according to the International Study Group of Pancreatic Surgery.


RESULTS
Twenty-two patients with binding pancreaticojejunostomy and 25 with conventional pancreaticojejunostomy were included. There was no difference concerning the rate of postoperative pancreatic fistula, but median delay for healing of postoperative pancreatic fistula was longer in the binding pancreaticojejunostomy group (29 vs. 9 days, p = 0.003). Postpancreatectomy hemorrhage was more frequent in the binding pancreaticojejunostomy group (6/22 vs. 0/25, p = 0.023).


CONCLUSIONS
Results of this study showed that binding pancreaticojejunostomy after pancreaticoduodenectomy was not associated with lower postoperative pancreatic fistula and moreover seems to increase postpancreatectomy hemorrhage.
Maggiori
Léon
L
Department of Hepato-Biliary and Pancreatic Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital (AP-HP), 100 boulevard du Général Leclerc, 92118, Clichy, France.
Sauvanet
Alain
A
Nagarajan
Ganesh
G
Dokmak
Safi
S
Aussilhou
Béatrice
B
Belghiti
Jacques
J
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult