Surgical loupes at 5.0× magnification and the VIO soft-coagulation system can prevent postoperative pancreatic fistula in duct-to-mucosa pancreaticojejunostomy

Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD). In this study, we examined whether our new method using surgical loupes at 5.0× magnification and the VIO soft coagulation system (SC) for duct-to-mucosa pancreaticojejunostomy (PJ) can prevent POPF. A retrospective cohort study was performed in 81 consecutive patients who underwent PD and duct-to-mucosa PJ for periampullary tumors by a single surgeon during a recent 5-year period from 2008 to 2012. These patients were divided into two groups according to the nature of the PJ; the conventional group (n=46) and the 5.0× loupes+SC group (n=35). Short-term surgical results including POPF were compared and an independent risk factor for POPF was identified using the stepwise logistic regression analysis in our series. The rate of Grade B/C POPF was significantly decreased in the 5.0× loupes+SC group (2.9%) compared to that of the conventional group (9.9%, p=0.04). The absence of 5.0× loupes+SC for PJ was identified as the independent risk factor for Grade B/C POPF (odds ratio, 5.23; p-value, 0.03). 5.0× surgical loupes+SC for duct-to-mucosa PJ could be used as a novel technique for preventing POPF after PD.