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A comparative study on the complications of conventional and end-to-side inserting pancreatojejunostomy after pancreaticoduodenectomy

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Abstract

Purpose

Pancreatico-digestive anastomosis is important in ensuring the safety of pancreaticoduodenectomy. This study compared the postoperative complications of a newly developed method of inserting end-to-side pancreaticojejunostomy with the conventional pancreaticojejunostomy after pancreaticoduodenectomy.

Methods

From April 2012 to December 2015, 108 consecutive patients underwent pancreaticoduodenectomy at Kumamoto University Hospital. A modified child’s reconstruction was performed with the inserting or conventional pancreaticojejunostomy. The clinical course and the incidence of postoperative complications were retrospectively evaluated.

Results

Five patients were excluded, four who underwent hepato-pancreatoduodenectomy and one who did not require pancreaticojejunostomy because of an atrophic pancreatic remnant. Of the 103 patients that were included in the analysis, 41 and 62 underwent surgery with the inserting and conventional methods, respectively. The incidence of postoperative Clavien–Dindo grade > II complications was similar in the two groups [36.6 % (15/41) vs 27.4 % (17/62)]. However, the rates of grade C postoperative pancreatic fistula [7.3 % (3/41) vs 0 % (0/62) P = 0.030] and re-operation for postoperative complications [14.6 % (6/41) vs 3.2 % (2/62), P = 0.034] were significantly higher in the inserting group than in the conventional group. There were no in-hospital deaths in either group.

Conclusions

The conventional pancreaticojejunostomy is safer than the end-to-side inserting pancreaticojejunostomy, as the latter is associated with a risk of severe complications. Improvements in pancreatico-digestive anastomosis techniques are required.

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Acknowledgments

No funding was received for this study.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Daisuke Hashimoto, Akira Chikamoto & Hideo Baba

  2. Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Norifumi Harimoto, Toru Ikegami, Hideaki Uchiyama, Tomoharu Yoshizumi & Yoshihiko Maehara

Authors
  1. Daisuke Hashimoto
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  2. Akira Chikamoto
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  3. Norifumi Harimoto
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  4. Toru Ikegami
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  5. Hideaki Uchiyama
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  6. Tomoharu Yoshizumi
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  7. Hideo Baba
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  8. Yoshihiko Maehara
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Corresponding author

Correspondence to Hideo Baba.

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The authors declare no conflicts of interest in association with the present study.

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Hashimoto, D., Chikamoto, A., Harimoto, N. et al. A comparative study on the complications of conventional and end-to-side inserting pancreatojejunostomy after pancreaticoduodenectomy. Surg Today 47, 238–244 (2017). https://doi.org/10.1007/s00595-016-1364-y

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  • DOI: https://doi.org/10.1007/s00595-016-1364-y

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