title: Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy.
abstract: OBJECTIVE
  The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy.
  
  
  METHODS
  Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA.
  
  
  RESULTS
  The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0Â±1.4/4.2Â±2.0mm, total number of sutures for DMA was 6.8Â±1.6/7.0Â±2.8, whereas mean interval between sutures was 1.4Â±0.5/2.1Â±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF.
  
  
  CONCLUSIONS
  The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. tac8@jikei.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Nojiri
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Ryohta
authors.initials: R
authors.lastname: Saitoh
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Usuba
authors.forename: Tadashi
authors.initials: T
authors.lastname: Uwagawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Syohichi
authors.initials: S
authors.lastname: Hirohara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D013537:Sutures