Use of pancreatic duct stents after pancreaticoduodenectomy.

After pancreaticoduodenectomy, the pancreatic anastomosis carries the highest risk of leak and cause of morbidity and mortality. In this review article, three randomized controlled clinical trials and a fourth prospective trial focused on pancreaticoduodenectomy that contribute to level-one evidence are examined. The Johns Hopkins group demonstrated that internal pancreatic duct stenting did not decrease the frequency or severity of postoperative pancreatic fistulas. The Queen Mary Hospital group demonstrated that external drainage of the pancreatic duct with a stent reduced the leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy. The University of Athens group demonstrated that internal stenting of the pancreaticojejunostomy anastomosis did not reduce the incidence of pancreatic fistula and related complications. Finally, the French Surgery Research Group demonstrated that the use of an external stent through the pancreatic anastomosis reduced the pancreatic fistula rate. In summary, two studies do not demonstrate an advantage to the use of internal pancreatic duct stents and two studies demonstrate a possible advantage to the use of external pancreatic duct stents, especially in highest risk patients with soft glands and small pancreatic ducts.