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Updated: Apr 5, 2026
Application of Simplified Stent-bridging Pancreaticogastrostomy in Open Pancreaticoduodenectomy
Published on: March 17, 2026
[Computed Tomography-Based Planimetry of the Pancreatic Transection Line in Risk Evaluation for Postoperative
H Riediger1, C M Krueger1, F Makowiec2
1Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
Background:
Postoperative pancreatic fistula is a relevant complication after pancreatoduodenectomy. Therefore, preoperative detection of high risk patients may be important. We evaluated preoperative CT-imaging by planimetry at the expected resection plane along the superior mesenteric vein and correlated the results with the incidence of postoperative pancreatic fistula.
Patients And Methods:
From 2009 to 2013, 123 patients with pancreatoduodenectomy underwent homogenous preoperative imaging and reconstruction of the pancreatojejunostomy. Planimetry was performed at a multiplanar reconstruction of the pancreatic transection plane (diameter, range, duct width, area) as well as the calculation of ratios (duct width/pancreatic diameter; D/P-ratio). The measured values were correlated with the incidence of postoperative pancreatic fistula.
Results:
Planimetry showed a significant difference of the pancreatic transection plane in relation to the incidence of postoperative pancreatic fistula. A thick parenchyma and a tiny duct are significant risk factors. In 84 % or, respectively, 94 % of the patients with postoperative pancreatic fistula, a duct width of less than 20 % of the pancreatic diameter was observed (D/P ratio < 0.2; p < 0.01). The D/P ratio was the only independent risk factor in multivariate analysis.
Discussion:
The incidence of postoperative pancreatic fistula correlates significantly with the morphology of the pancreatic transection plane. The risk increases significantly with a D/P ratio of < 0.2.
