Postoperative pancreatic fistulas after pancreaticoduodenectomy using the pair-watch suturing and duct-to-mucosa pancreaticojejunostomy anastomosis techniques

Abstract Background/Aims: Morbidity and mortality after pancreaticoduodenectomy (PD) have been associated with postoperative pancreatic fistula (POPF). Pancreatic anastomosis is challenging for most surgeons, and there is no universal or standardized technique. This study compared the incidence of POPF between the pair-watch suturing technique (PWST) and duct-to-mucosa pancreaticojejunostomy (PJ) anastomosis technique. Methods: This retrospective cohort analysis included 71 patients who underwent a PD between January 2009 and October 2018. The incidence and risk factors of complications after PWST and duct-to-mucosa PJ anastomoses were compared. Results: There was no significant difference in the incidence of POPF between the PWST (n=7; 30.4%) and duct-to-mucosa PJ (n=9; 18.7%) groups. The tumor site (p=0.001) and pancreas density on computed tomography without contrast (p=0.002) were significantly different between the groups. Age ≥60 years (odds ratio [OR]: 11.07; 95% confidence interval [CI]: 1.14–107.36; p=0.038) and pancreatic body mass/duct size (B/W) ratio (OR: 1.41; 95% CI: 1.04–1.91; p=0.029) were identified as significant risk factors for POPF. International Study Group for Pancreatic Fistula grade B POPF, wound infections, and pneumonia occurred more frequently in patients who underwent a duct-to-mucosa PJ anastomosis. However, the postoperative complications were not significantly different between the groups. Conclusions: The incidence of clinically relevant POPF was similar between patients who underwent the PWST and those who underwent a duct-to-mucosa PJ anastomosis. However, a preoperative risk factor assessment for the evaluation of the tumor site, patient age, and B/W ratio could help determine which surgical technique should be used in individual patients.