A PERSONAL INVAGINATION PANCREATICOJEJUNOSTOMY TECHNIQUE AFTER PANCREATICODUODENECTOMY: DESCRIPTION, TECHNICAL DETAILS AND RESULTS

Background: One of the most critical steps of the pancreaticoduodenectomy (PD) is the treatment of pancreatic stump, as anastomotic leak is the cause of major morbidity and mortalityof the entire intervention. There is still no universally accepted technique for pancreaticojejunostomy (PJ). Aim: To describe our new personal invagination PJ technique (piPJ)and compare the perioperative outcomes with data reported in the literature Patients & methods: From November 2010 we used a new personal invagination PJ technique (piPJ) on 84 patients. We hereby describe the technical details the Fistula Risk Score, the presence of post-operative pancreatic fistulas(POPF;ISGPF Classification) and the perioperative outcomes of patients treated with this piPJ technique. Results: POPF occurred in 14/84 (16.67%). Grade A of POPF was found in 9/84 patients (10.71%), Grade B of POPF in 4/84 patients (4.76%). The presence of Grade C pancreatic fistulas was documented in one 1/84 patients (1.19%). Patients were stratified into four groups according to the risk of pancreatic fistula (Fistula Risk Score, FRS). We documented that the fistula rate in patients with high risk (FRS 7-10) was less than the expected found in literature (21,43% vs 50,0%), while with low and intermediate FRS was comparable to that expected. . The re-operation rate was 3.58% (3/84)whereas the specific mortality rate for POPF was 1.19% (1/84). Conclusion: The piPJ technique was found to be safe and resulted in satisfactory postoperative outcome. The percentage of pancreatic fistula seems to be less than expected in particular for the "difficult" pancreas with high FRS