Related Experiment Video
Updated: Jan 7, 2026
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
Pancreatico-Jejunostomy Fistula After Pancreaticoduodenectomy: Where Do We Stand? Results from an International
Silvio Caringi1,2, Michele Tedeschi1,3, Antonella Delvecchio1
1Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy.
Introduction:
Pancreatico-duodenectomy (PD) remains one of the most complex abdominal surgeries, and pancreatico-jejunostomy (PJ) fistula is its most critical postoperative complication. In efforts to reduce the incidence of postoperative pancreatic fistula (POPF), several PJ techniques and adjuncts, including stents, have been recommended. This article presents data from an international survey regarding PJ methods, the use of pancreatic stents, and their correlation with POPF rates from surgical centers worldwide.
Methods:
A nine-item online questionnaire was sent globally through social networks, individual mailing lists, and the ASHBPS mailing list. Data were analyzed through the Student's t-test (two-tailed, unequal variance). A p-value < 0.05 was considered to be statistically significant.
Results:
A total of 122 units of pancreatic surgery from 26 countries distributed across five continents responded to the survey. Most centers performed less than 50 PDs a year, preferred a duct-to-mucosa PJ, and employed a stent routinely. Mean POPF grade B and C incidences were lower in high-volume (15.24% ± 7.29 and 3.95% ± 2.39) and in PJ stent-using centers (16.25% ± 8.7 and 5.37% ± 7.49).
Conclusions:
Institutional case volume and stent usage are more crucial determinants of POPF incidence than the PJ technique itself. Centralization and standardization of PD procedures are related to reductions in major fistula rates.
