Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy.

Abstract

BACKGROUND/AIMS:

The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy.

METHODOLOGY:

Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA.

RESULTS:

The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF.

CONCLUSIONS:

The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.

• Authors: Takuya Nojiri, Takeyuki Misawa, Ryohta Saitoh, Hiroaki Shiba, Teruyuki Usuba, Tadashi Uwagawa, Shigeki Wakiyama, Syohichi Hirohara, Yuichi Ishida, Katsuhiko Yanaga
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2011 Jul-Aug Vol. 58 Issue 109 Pg. 1368-71 ISSN: 0172-6390 [Print] Greece
• PMID: 21937409 (Publication Type: Journal Article)

Topics

• Aged
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Pancreatic Fistula (epidemiology, etiology)
• Pancreaticojejunostomy (adverse effects)
• Postoperative Complications (etiology)
• Risk Factors
• Sutures