title: Pancreatoduodenectomy with a modified duct-to-mucosa pancreaticojejunostomy: an analysis of 101 consecutive patients.
abstract: OBJECTIVE
  The aim of the study was to analyze in-hospital morbidity and mortality after pancreatoduodenectomy (PD) with a modified duct-to-mucosa pancreaticojejunostomy.
  
  
  METHODS
  We retrospectively analyzed 101 consecutive patients who underwent PD at our center between January 2002 and December 2010. Two-layered duct-to-mucosa pancreaticojejunostomy was performed over an internal transanastomotic stent in all patients.
  
  
  RESULTS
  The overall in-hospital morbidity and mortality rate was 48% and 6%, respectively. Three patients died as a consequence of local complications including mesenteric ischemia in two and acute necrotizing pancreatitis in one case. Pancreatic fistula occurred in one (1%) patient and was treated conservatively with good outcome. The wound infection was the most common surgical complication (20/101; 20%) and occurred more often in patients who had a biliary stent inserted endoscopically prior to surgery (15/38; 39%), as compared to those without the stent (5/63; 8%; p=0.0003).
  
  
  CONCLUSIONS
  The results of the present study suggest that a two-layered duct-to-mucosa pancreaticojejunostomy with internal transanastomotic stent is a safe anastomosis, associated with a very low risk of pancreatic fistula. The presence of a biliary stent at the time of surgery represents a risk factor for the development of postoperative wound infection.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, M.Curie Hospital, Szczecin, Poland. drmwojcicki@wp.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Wojcicki
authors.forename: Mariola
authors.initials: M
authors.lastname: Post
authors.forename: Konrad
authors.initials: K
authors.lastname: Jarosz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bialek
authors.forename: Anna
authors.initials: A
authors.lastname: Wiechowska-Kozlowska
authors.forename: Piotr
authors.initials: P
authors.lastname: Milkiewicz
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lubikowski
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001650:Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult