| BackgroundPancreatic fistula (PF) is the most frequently and severe problems after pancreaticoduodenectomy (PD).Invagination and duct-to-mucosa pancreaticojejunostomies (PJs) are two common methods for reconstruction after PD. At present, most of literature reports have the similar PF rates between the two anastomotic methods. But these studies always include more than one institute or surgeon. The PF rates will be influenced because of the difference in techniques, diagnosis, and treatment existed among different surgeons. The aim of our study is to evaluate the possible difference of PF between two different methods of pancreaticojejunal reconstruction.MethodsBetween October2012and March2015, we randomly assigned132participants who underwent PJs to the invagination group and the duct-to-mucosa group. One surgeon performed all PJs. The primary end point was PF, the occurrence and grade of which were diagnosed according to the International Study Group on Pancreatic Fistula. The secondary end points included mortality, complications, and postoperative hospital stay. Predictable factors of PF were also explored using multivariate analysis.ResultsThe entire PF rate was29.5%, with a clinical relevant PF (CR-PF) rate of10.6%. There were no significant differences between the invagination and duct-to-mucosa groups (30.9%vs.28.5%; P=0.729). However, the invagination group had more proportion of CR-PF (P=0.004). Consistently, more severe complications were found in the invagination group (P=0.013), although the whole morbidities were similar. There was only one perioperative death, happened in the invagination group. Firm pancreas was associated with less PF rate (P=0.013). Diameter of duct of Wirsung, pathology, and gender were identified as independent predictable factors of PF.ConclusionThe morbidity was no significant different in the two groups. But the morbidity was more severe and the POPH was longer in the invagination group. |
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