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Pancreas:
doi: 10.1097/MPA.0b013e3181b57705
Online Articles

Pancreatic Leakage After Pancreaticoduodenectomy: The Impact of the Isolated Jejunal Loop Length and Anastomotic Technique of the Pancreatic Stump

Fragulidis, Georgios P. MD, PhD; Arkadopoulos, Nikolaos MD, PhD; Vassiliou, Ioannis MD, PhD; Marinis, Athanasios MD, PhD; Theodosopoulos, Theodosios MD, PhD; Stafyla, Vaia MD, PhD; Kyriazi, Maria MD; Karapanos, Konstantinos MD; Dafnios, Nikolaos MD, PhD; Polydorou, Andreas MD, PhD; Voros, Dionysios MD, PhD; Smyrniotis, Vassilios MD, PhD

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Abstract

Objectives: To evaluate the impact of the length of the isolated jejunal loop and the type of pancreaticojejunostomy on pancreatic leakage after pancreaticoduodenectomy.

Methods: One hundred thirty-two consecutive patients who underwent a pancreaticoduodenectomy were studied according to the length of the isolated jejunal loop (short loop, 20-25 cm vs long loop, 40-50 cm) and the type of pancreaticojejunostomy (invagination vs duct to mucosa).

Results: The use of the long isolated jejunal loop was associated with a significantly lower pancreatic leakage rate compared with the use of a short isolated jejunal loop (4.34% vs 14.2%, P < 0.05). In addition, the use of duct-to-mucosa technique was associated with significantly lower incidence of postoperative pancreatic fistula compared with the invagination technique (4.2% vs 14.5%, P < 0.05). Finally, patients with a short isolated jejunal loop compared with patients with a long loop had increased morbidity (50.7% vs 27.5%, P < 0.05) and prolonged hospital stay (16.3 ± 1.9 days vs 10.2 ± 2.3 days, P < 0.05). Overall mortality rate was 1.5%.

Conclusions: The use of a long isolated jejunal loop and a duct-to-mucosa pancreaticojejunostomy is associated with decreased pancreatic leakage rate after pancreaticoduodenectomy.

© 2009 Lippincott Williams & Wilkins, Inc.

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