Outcomes after pancreaticoduodenectomy with 12 stitches duct-to-mucosa pancreaticojejunostomy

Background: To prevent the postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), we have used a standardized duct-to-mucosa pancreaticojejunostomy (PJ), named “pair-watch suturing technique (PWST)” since 2007, in which 12 stitches (6-0) are put on duct-to-mucosa PJ regardless of the diameter of pancreatic duct. The aim of this study was to evaluate the complications after PD with PWST. Patients and methods: The subjects were the consecutive 341 patients who underwent PD with PWST from April 2007 to March 2017. We evaluated complications according to Clavien-Dindo classification. Especially POPF was also evaluated according to ISGPF classification. Results: Median age of subjects was 69 years old. The 206 patients were male and 135 were female. Pancreatic cancer was shown in the 171 patients (50.1%), soft pancreas in 150 (44.0%), dilated pancreatic duct (more than 3mm) in 178 (52.2%) and pancreatic stent placement 179 (52.5%). The incidence of clinically relevant postoperative pancreatic fistula (CR-POPF: ISGPF grades B and C) was 11.4% (n = 39). Clavien-Dindo classification of these 39 patients with CR-POPF was grade II in 9, grade IIIa in 24, grade IVa in 2, grade IVb in 2 and grade V in 2. Severe complications (grade IIIa or more) were found in 103 patients (30.2%): CR-POPF (8.2%, n = 28), intra-abdominal abscess (6.7%, n = 23), bleeding (n = 14, 4.1%), pneumonia (n = 8, 2.3%) and others (n = 23). Conclusion: Our standardized duct-to-mucosa PJ using PWST is a safe and reliable procedure regardless of pancreatic duct size and pancreatic texture.