Toward zero pancreatic leakage after pancreaticoduodenectomy for soft pancreas in low-volume pancreatic surgery centers.

Pancreatic leakage continues to occur after pancreaticoduodenectomy (PD) and it is a serious problem. It has been proposed that a normal-sized, soft, friable, and functionally normal pancreas with a thin-walled main pancreatic duct is at a greater risk of anastomotic leakage. However, despite the evaluation of various improvised procedures, pancreatic leakage persists as a complication. Here, we describe our PD technique that facilitates the prevention of pancreatic leakage. Our operative procedures includes 3 stages: pancreaticogastrostomy (PG), external and continuous suction drainage of pancreatic juice, and wrapping of the pancreatic anastomosis by using round ligament and applying fibrin glue sealant to the surface of the pancreatic anastomosis. Twenty-six patients with periampullary malignancy with soft pancreas underwent PG without any pancreatic leakage or fistula. The combined procedures, including PG, total external drainage with continuous suction of the pancreatic juice, and wrapping of the pancreatic anastomotic site by using round ligament is a useful method to prevent pancreatic leakage for cases of soft pancreas in pancreatic centers that do not encounter many such cases.