Pancreato-jejunostomy – the achilles’ heel of pancreatic resectional surgery
DOI:
https://doi.org/10.5281/zenodo.15254431Keywords:
pancreatic head carcinoma, duodeno-hemipancreatectomy, pancreatojejunostomy, duct-to-mucosa anastomosis, postoperative pancreatic fistulaAbstract
INTRODUCTION: Pancreato-jejunostomy (PJS) gained the glory of „Achilles heel” of duodeno-hemipancreatectomy (DHPE) even in the 70s of the past century. It still has such a characteristic because of the high incidence rate of pancreatic leakage leading to dangerous secondary complications.
Aim: Comparative analysis of ourinstitutional experience with the different techniques of pancreatic anastomoses.
MATERIAL AND METHODS: A retrospective single-centre study was performed on 236 cases with DHPE and PJS between 2009-2020. Many factors determined the choice of surgical technique. Pancreaticremnant characteristics were of utmost importance – size, texture and main pancreatic duct (MPD) diameter. Duct-to-mucosa anastomosis received 166 patients (70%). Internal pancreatic inter-anastomotic stenting was used in 160 cases (68%), and 59 (25%) PJS were protected by external inter-anastomotic drainage.
The International Study Group on Pancreatic Fistula (ISGPF) definitions and criteria were used to detect pancreatic leakage (postoperative pancreatic fistula = POPF).
RESULTS: POPF were registered after 74 procedures (31,3%). Twenty-seven of them (11.4%) were clinically significant (febrile conditions, increased WBC, SIRS, Sepsis, delayed drainage removal). The incidence rate of POPF did not demonstrate statistically significant dependence on the type of anastomosis.
The characteristics of the pancreatic remnant, the reconstruction type (Roux-en-Y or omega) and the usage of protective interanastomotic drainage demonstrated statistical significance.
DISCUSSION: There is no all-purpose and a hundred percent reliable PJS. According to literature data, POPF ranks first among all specific complications with a frequency rate of 10-30% (even 50% in some series!). It affected 31.4 % of our cases. The solid parenchyma and dilated MPD increase the range of choice of a surgical technique, but those are factors which we cannot influence. Interanastomotic protective drainage also enables its healing. That is why we always imply it in our practice.
KEY WORDS: pancreatic head carcinoma, duodeno-hemipancreatectomy, pancreatojejunostomy, duct-to-mucosa anastomosis, postoperative pancreatic fistula
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