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Updated: May 29, 2026
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy
Takuya Nojiri1, Takeyuki Misawa, Ryohta Saitoh
1Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. tac8@jikei.ac.jp
Background/Aims:
The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy.
Methodology:
Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA.
Results:
The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF.
Conclusions:
The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.
Insights
Surgical technique impacts postoperative pancreatic fistula (POPF) risk. Using smaller sutures (5-0) and careful pancreatic handling can reduce POPF after pancreaticojejunostomy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication after pancreaticojejunostomy.
- Identifying modifiable risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine key risk factors for POPF following pancreaticojejunostomy.
- To evaluate the influence of surgical technique on POPF development.
Main Methods:
- A retrospective analysis of 71 patients undergoing pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA).
- Comparison of clinical parameters including pancreatic texture, duct diameter, suture characteristics, and interval between sutures between POPF and non-POPF groups.
Main Results:
- Pancreatic texture (soft pancreas) and smaller suture size (5-0) were significantly associated with a lower incidence of POPF.
- Multivariate analysis confirmed suture size and pancreatic texture as independent risk factors for POPF.
- No significant differences were observed in pancreatic duct diameter, total number of sutures, or interval between sutures.
Conclusions:
- Suture size and pancreatic texture are critical risk factors for POPF.
- Gentle surgical handling during pancreaticojejunostomy, particularly concerning suture selection and pancreatic manipulation, is essential for minimizing POPF.
