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• W2891689295 abstract "Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains one of the most common causes of morbidity and mortality in patients undergoing pancreatic surgery. There has been conflicting and limited evidence as to whether there is any significant difference in the incidence of CR-POPF with a Duct-to-Mucosa (DTM) technique versus an Invagination (IG) technique for the creation of a Pancreaticojejunal (PJ) anastomosis after pancreaticoduodenectomy. Methods: Demographic, comorbidity, perioperative, intraoperative, and outcomes data were captured from the ACS National Surgical Quality Improvement Program (NSQIP) 2014–2015 database. Continuous and categorical variables were compared, and significant variables utilized in backward step-wise method multivariate model as they related to the technique of PJ during pancreaticoduodenectomy (PD). The primary outcome was CR-POPF, which includes pancreatic fistula grades B and C. Results: Amongst the 6,125 PJ anastomoses performed during PD, there were 5,496 performed with a DTM approach and 629 with an IG approach. There were no significant differences in baseline demographics, however, there were significant differences in the two techniques with respect to pylorus preserving vs. classic (p < 0.001), pancreatic duct size (p < 0.001) and operative time (p < 0.001). Univariate analysis revealed a lower incidence of CR-POPF in DTM compared to IG approach (OR = 0.69, CI = 0.52–0.92, p = 0.011); however, when controlled for confounding variables, there was no association between technique and fistula formation (OR = 0.72, CI = 0.48–1.08, p = 0.12). Conclusion: This study supports the concept that PJ anastomosis technique does not predict CR-POPF, and that surgeons should be compelled to use the technique they feel most comfortable with regardless of the gland texture or duct size.Table 1Multivariate comparison of P-J repair on risk of CR-POPFVariableOR (SE)p-Value (95%CI)Univariate analysisDuct-to-mucosa vs. invagination0.69 (0.10)0.011 (0.52–0.92)Multivariate analysisDuct-to-mucosa vs. invagination0.72 (0.15)0.12 (0.48–1.08)Multivariate adjusted for gender, BMI, pre-operative bilirubin, pre-operative stent, tumor histology, diabetes, sepsis, drain, pylorus preserving technique, pancreatic duct size, gland texture and operative time. Open table in a new tab Multivariate adjusted for gender, BMI, pre-operative bilirubin, pre-operative stent, tumor histology, diabetes, sepsis, drain, pylorus preserving technique, pancreatic duct size, gland texture and operative time." @default.
• W2891689295 created "2018-09-27" @default.
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• W2891689295 date "2018-03-01" @default.
• W2891689295 modified "2023-09-29" @default.
• W2891689295 title "An analysis of 6,125 pancreaticojejunal anastomoses: does technique matter?" @default.
• W2891689295 doi "https://doi.org/10.1016/j.hpb.2018.02.261" @default.
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