title: "True" duct-to-mucosa pancreaticojejunostomy, with secure eversion of the enteric mucosa, in Whipple operation.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call "true" duct-to-mucosa anastomosis (DMA)-pancreaticojejunostomy.
  
  
  METHODS
  A novel enteric mucosal eversion at the point of the jejunostomy is constructed prior to the anastomosis with the pancreatic duct in order to enhance sealing. This technique was tested in a series of 38 patients (study group) and compared to the technique used in the preceding 35 patients who served as controls.
  
  
  RESULTS
  The incidence of POPF was significantly lower in the study group compared to controls: 7.9 % (3/38) vs 34.3 % (12/35), respectively (P = 0.008, odds ratio 6.1). All POPFs in the study group were International Study Group on Pancreatic Fistula (ISGPF) grade A, while in the control group POPFs ISGPF grade B and C occurred in 17.1 %. Additionally, median (interquartile range) postoperative hospitalization was reduced in the study group [16 (14-21) days] compared to controls [20 (16-27) days, P = 0.005].
  
  
  CONCLUSIONS
  The "true" DMA technique appears to be one of the safest techniques reported to date. The modifications presented herein can easily be adopted by experienced surgeons already performing other techniques of duct-to-mucosa anastomosis.
authors.affiliation: Department of Surgery, University of Patras Medical School, Patras, Greece, dkarav@med.upatras.gr.
authors.forename: Dionissios D
authors.initials: DD
authors.lastname: Karavias
authors.forename: Dimitrios D
authors.initials: DD
authors.lastname: Karavias
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Chaveles
authors.forename: Stavros K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: Nicolaos A
authors.initials: NA
authors.lastname: Katsiakis
authors.forename: Ioannis C
authors.initials: IC
authors.lastname: Maroulis
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome