Pancreatic division by electrocautery in pancreatoduodenectomy

To assess whether electrocautery is appropriate for cutting the pancreas in pancreatoduodenectomy, we compared leakage of the pancreatojejunostomy (PJ-stomy) in patients who underwent pancreatic division by electrocautery and with a conventional scalpel, in a retrospective study. Eighty-four patients with invaginating end-to-end PJ-stomies (performed in the period 1986-1996) were enrolled in this study; 34 patients underwent pancreatic division with a conventional scalpel (group A) and 50 by electrocautery (group B). Of the 84 patients, 12 (14%) had leakage from the PJ-stomies. In relation to consistency of the pancreatic parenchyma, the incidence of leakage in patients with hard pancreas (1/28; 3.6%) was significantly lower than that in patients with soft or moderate pancreas consistency (11/56; 20%) (P < 0.05). Nine patients (27%) in group A and 3 (6%) in group B presented with leakage. The incidence of leakage was significantly lower in group B than in group A (P < 0. 05). Even when patients with hard pancreas were excluded, the incidence of leakage was significantly lower in group B (3/34; 9%) than in group A (8/22; 36%) (P < 0.05). These results suggest that pancreatic division by electrocautery can reduce the incidence of leakage from the pancreatojejunostomy and make pancreatoduodenectomy a safer procedure.