Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy

Background The leading cause for morbidity and mortality after pancreaticoduodenectomy is a pancreatic anastomotic leak and fistula. The two most commonly performed anastomoses after pancreaticoduodenectomy are pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ). The role of standardization on outcomes after pancreaticoduodenectomy has not been sufficiently addressed. Aim The goal is to study the impact of a standardized technique of pancreatic anastomosis (PJ) after pancreaticoduodenectomy in a tertiary referral cancer teaching hospital. Materials and methods A single-institution database was analyzed over 15 years. The entire data were subdivided into two periods, viz., period A (1992 to 2001), when PG (dunking) was predominantly used, and period B (2003-2007), when a standardized technique of PJ (duct to mucosa) was employed. Results There were 144 pancreaticoduodenectomies performed during period A with a pancreatic fistula rate of 16%. During period B, 123 pancreaticoduodenectomies were performed with a pancreatic fistula rate of 3.2%(p<0.0005). Conclusions It appears that a standardized approach to the pancreatic anastomosis and a consistent practice of a single technique can help to reduce the incidence of complications after pancreaticoduodenectomy.