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Pancreaticojejunostomy with duct-to-mucosa versus invagination techniques: a propensity-score matching analysis based on pancreatic duct size and gland texture

  • 0Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Division of Surgical Oncology, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
American Journal of Surgery +

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October 10, 2025

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October 10, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

This study found no difference in pancreatic fistula rates between duct-to-mucosa (DTM) and invagination (IVG) techniques for pancreaticoduodenectomy, regardless of duct size or texture. Invagination may lead to earlier drain removal in some cases.

Area Of Science

  • Gastroenterology
  • Surgical Oncology
  • Pancreatic Surgery

Background

  • The optimal surgical technique for pancreaticoduodenectomy remains debated.
  • Duct-to-mucosa (DTM) and invagination (IVG) are common reconstruction methods.
  • This study is the largest to compare DTM and IVG using detailed patient data.

Purpose Of The Study

  • To compare the outcomes of DTM versus IVG techniques in pancreaticoduodenectomy.
  • To analyze outcomes based on pancreatic duct size and gland texture.
  • To determine the impact of technique on postoperative pancreatic fistula (POPF).

Main Methods

  • Utilized the NSQIP database for open pancreaticoduodenectomy cases.
  • Subgrouped patients by pancreatic duct size (<3mm, 3-6mm, >6mm) and gland texture (soft, intermediate, hard).
  • Employed propensity score matching (PSM) for robust comparison.

Main Results

  • No significant differences in POPF rates were observed between DTM and IVG across all duct size and gland texture subgroups after PSM.
  • The IVG technique showed a trend towards shorter postoperative drain presence duration in patients with 3-6mm ducts.
  • Secondary outcomes did not reveal significant variations between the techniques.

Conclusions

  • DTM and IVG techniques demonstrate comparable safety profiles regarding POPF in pancreaticoduodenectomy.
  • Surgical technique choice may not significantly impact fistula rates when considering duct size and texture.
  • IVG might offer a slight advantage in reducing drain-related complications in specific patient subsets.

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