title: A safe and feasible "clock-face" duct-to-mucosa pancreaticojejunostomy with a very low incidence of anastomotic failure: A single center experience of 248 patients.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is one of the most frequent and serious postoperative complications of pancreatoduodenectomy (PD). We sought to assess the impact of a novel pancreaticojejunostomy (PJ) on the rates of POPF and overall postoperative complications.
  
  
  METHODS
  Between 01/2010 and 12/2013, a total of 248 consecutive patients who underwent PD with a modified PJ were identified from our database and retrospectively analyzed. POPF cases were divided into three categories (ISGPF-international study group-guidelines): biochemical fistula without clinical sequelae (grade A), fistula requiring any therapeutic intervention (grade B), and fistula with severe clinical sequelae (grade C). Perioperative outcomes were recorded and analyzed.
  
  
  RESULTS
  The overwhelming majority of patients had no evidence of fistula. Grade A POPF was observed in 9 (3.62%), grade B in 1 (0.40%), and grade C in 0 patients. There were no postoperative deaths. Overall complications occurred in 61 patients (24.59%) of patients after PD.
  
  
  CONCLUSIONS
  This modified pancreaticojejunostomy is widely applicable and is associated with very low rates of POPF, low postoperative morbidity and mortality. Overall, it is a feasible and safe novel approach with excellent short-term outcomes.
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; 1st Department of Surgery, University of Athens, Laikon General Hospital, Agiou Thoma 17 street, 11527 Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Papalampros
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Niehaus
authors.affiliation: 1st Department of Surgery, University of Athens, Laikon General Hospital, Agiou Thoma 17 street, 11527 Athens, Greece. Electronic address: dimmoris@yahoo.com.
authors.forename: D
authors.initials: D
authors.lastname: Moris
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Fard-Aghaie
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Stavrou
authors.affiliation: 1st Department of Surgery, University of Athens, Laikon General Hospital, Agiou Thoma 17 street, 11527 Athens, Greece.
authors.forename: A-G
authors.initials: AG
authors.lastname: Margonis
authors.affiliation: 1st Department of Surgery, University of Athens, Laikon General Hospital, Agiou Thoma 17 street, 11527 Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Angelou
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Oldhafer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: Pancreatic Fistula; Pancreatic surgery; Pancreaticojejunostomy