Comparison of early postoperative outcomes between omega-like duct-to-mucosa pancreatojejunostomy and conventional duct-to-mucosa pancreatojejunostomy after pancreaticoduodenectomy

Background: Pancreatic fistula is a life-threatening complication of pancreaticoduodenectomy. Omega-like duct-to-mucosa pancreatojejunostomy is a novel technique which helps reduce the risk of fistulation. This study aimed to compare early postoperative outcomes of omega-like and conventional pancreatojejunostomy. Methods: A retrospective single-centre cohort study comparing outcomes of adult patients who underwent open pancreatoduodenectomy with conventional (CDMP) or omega-like duct-to-mucosa pancreatojejunostomy (ODMP) between 1 January 2015 and 31 December 2019. The primary outcome measure was the pancreatic fistula rate. Results: 440 patients were included in this study of whom 233 underwent CDMP and 207 ODMP. The rate of clinically relevantpancreatic fistula (grade B/C) was significantly higher after CDMP than ODMP (18.5% vs. 10.6%, P = 0.021). 153 patients in CDMP group and 99 patients in ODMP group developed one or more complications (65.7% vs. 47.8%, P = 0.004). The average hospitalization expenses were numerically decreased in ODMP group, although this was not statistically significant (120,000 +/- 42,000 [Chinese Yuan] vs. 100,000 +/- 40,000 [Chinese Yuan] or 18,581 +/- 6503 [United States Dollar] vs. 15,484 +/- 6194 [United States Dollar], P = 0.402). Conclusion: ODMP may reduce the incidence of pancreatic fistula and other early postoperative complications after pancreatoduodenectomy.