INTRODUCTION: A soft pancreas has been associated with an increased risk of post-operative pancreatic fistula formation. Few studies have evaluated the effect of anastomotic technique (duct to mucosa vs invagination) on fistula formation. This study aims to compare the effect of anastomotic technique on fistula formation among patients with a soft pancreas in a large multiinstitutional database. METHODS: The targeted pancreas module of the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Database was used. All patients with a soft pancreas who underwent pancreaticoduodenectomy from 2014 to 2015 were identified. Demographic data, comorbid conditions, operative variables, and 30-day outcomes were compared using univariate and multivariable analyses. RESULTS: A total of 975 patients met inclusion criteria. Eight-hundred fifty four (88%) underwent a duct to mucosa pancreaticojejunostomy technique and 121 (12%) underwent invagination. Patients who underwent invagination had higher 30-day mortality (5.8% vs 1.4%, p < 0.01), higher fistula formation (38% vs 25%, p < 0.01), and more often had percutaneous drain placement post-operatively (27% vs 14%, p < 0.01). Following multivariable analysis, invagination remained associated with pancreatic fistula formation (OR 2.5, CI 1.4-4.3) and post-operative percutaneous drain placement (OR 1.8, CI 1.1-2.9). CONCLUSION: Invagination technique for pancreaticojejunostomy in patients with a soft pancreas is associated with increased rates of pancreatic fistula. Surgeons should consider utilizing a duct to mucosa technique when feasible to decrease morbidity following pancreaticoduodenectomy in this patient population.
INTRODUCTION:A soft pancreas has been associated with an increased risk of post-operative pancreatic fistula formation. Few studies have evaluated the effect of anastomotic technique (duct to mucosa vs invagination) on fistula formation. This study aims to compare the effect of anastomotic technique on fistula formation among patients with a soft pancreas in a large multiinstitutional database. METHODS: The targeted pancreas module of the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Database was used. All patients with a soft pancreas who underwent pancreaticoduodenectomy from 2014 to 2015 were identified. Demographic data, comorbid conditions, operative variables, and 30-day outcomes were compared using univariate and multivariable analyses. RESULTS: A total of 975 patients met inclusion criteria. Eight-hundred fifty four (88%) underwent a duct to mucosa pancreaticojejunostomy technique and 121 (12%) underwent invagination. Patients who underwent invagination had higher 30-day mortality (5.8% vs 1.4%, p < 0.01), higher fistula formation (38% vs 25%, p < 0.01), and more often had percutaneous drain placement post-operatively (27% vs 14%, p < 0.01). Following multivariable analysis, invagination remained associated with pancreatic fistula formation (OR 2.5, CI 1.4-4.3) and post-operative percutaneous drain placement (OR 1.8, CI 1.1-2.9). CONCLUSION: Invagination technique for pancreaticojejunostomy in patients with a soft pancreas is associated with increased rates of pancreatic fistula. Surgeons should consider utilizing a duct to mucosa technique when feasible to decrease morbidity following pancreaticoduodenectomy in this patient population.
Authors: Claudio Bassi; Christos Dervenis; Giovanni Butturini; Abe Fingerhut; Charles Yeo; Jakob Izbicki; John Neoptolemos; Michael Sarr; William Traverso; Marcus Buchler Journal: Surgery Date: 2005-07 Impact factor: 3.982
Authors: Adam C Berger; Thomas J Howard; Eugene P Kennedy; Patricia K Sauter; Maryanne Bower-Cherry; Sarah Dutkevitch; Terry Hyslop; C Max Schmidt; Ernest L Rosato; Harish Lavu; Atilla Nakeeb; Henry A Pitt; Keith D Lillemoe; Charles J Yeo Journal: J Am Coll Surg Date: 2009-05 Impact factor: 6.113
Authors: Abhishek Mathur; Henry A Pitt; Megan Marine; Romil Saxena; C Max Schmidt; Thomas J Howard; Attila Nakeeb; Nicholas J Zyromski; Keith D Lillemoe Journal: Ann Surg Date: 2007-12 Impact factor: 12.969