Pancreaticojejunostomy After Normal Soft Pancreaticoduodenectomy: A Study of the No-Stent Method

There is high risk for anastomotic leakage after pancreaticojejunostomy in pancreaticoduodenectomy (PD) of the normal pancreas because the pancreas is soft and its exocrine activity is high. In this type of PD, a procedure with stent tubing is generally performed (stent method). In recent years, we have performed pancreaticojejunostomy after PD using a procedure without stent tubing (no-stent method) and obtained good results. The intent of this anastomotic technique is to preserve adequate patency of the pancreatic duct by carefully picking up the pancreatic duct wall with a fine atraumatic needle and monofilament sutures. The results of pancreaticojejunostomy after normal soft PD were compared between the no-stent method (group A, 28 cases) and the stent method (group B, 20 cases). There were no differences between the groups in background characteristics of patients, including underlying diseases and age. The mean operative time was 258 min in group A and 283 min in group B; mean pancreaticojejunostomy time was 27.2 and 23.0 min, respectively. Mean perioperative blood loss was less in group A (1075 ml) than in group B (1280 ml). The morbidity rate of early postoperative complications was 32% and 30%, with a frequency of pancreatic-enteric anastomotic leakage of 14% and 15%, respectively, showing no substantial differences. Mean time to postoperative intake of solid food was 15.1 and 17.7 days, and mean postoperative hospital stay 27.3 and 31.3 days, respectively, showing a slight tendency toward fewer days in group A. As shown, we could perform pancreaticojejunostomy safely after normal soft PD without using a stent tube and with no major postoperative complications.