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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

doi: 10.1097/MPA.0b013e3181b57705
Online Articles

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.

From the Second Department of Surgery, Aretaieion University Hospital, Athens Medical School, University of Athens, Athens, Greece.

Received for publication September 23, 2008; accepted June 17, 2009.

Reprints: Georgios P. Fragulidis, MD, PhD, 23 El. Venizelos Str, 16675 Athens, Greece (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.