Safety of Non-Stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

Background/Aim: It has been reported that pancreatic duct stenting for pancreaticojejunostomy in pancreaticoduodenectomy prevents postoperative pancreatic fistula. However, some reports describe severe complications associated with pancreatic duct stenting; it is controversial whether pancreatic duct stent should be used for pancreaticojejunal anastomosis in pancreaticoduodenectomy. The aim of this study was to compare the incidence of pancreatic fistula between non-stented, externally stented, and internally stented pancreaticojejunostomy in pancreaticoduodenectomy for patients with soft pancreas. Patients and Methods: Ninety-eight patients undergoing pancreaticoduodenectomy with soft pancreas were divided into three groups: a non-stented group (n=14), an externally-stented group (n=56), and an internally-stented group (n=28), then clinical outcomes were compared. Results: The frequency of clinically relevant postoperative pancreatic fistula (grade B or C) was 14% in the non-stented group, 36% in the externally-stented group, and 39% in the internally-stented group, respectively (p=0.19). The morbidity and mortality rates were also comparable between the three groups (p=0.17 and p=0.88, respectively). Conclusion: Since pancreatic duct stenting in pancreaticojejunal anastomosis for patients with soft pancreas did not reduce pancreatic fistula after pancreaticoduodenectomy, non-stented pancreaticojejunostomy for soft pancreas seems safe.