Effect of Anastomosis Technique on Pancreatic Fistula Formation in Proximal Pancreaticoduodenectomy

Objective: To find out the association between the pancreatic fistula development and the pancreaticoduodenectomy anastomosis technique performed in three different ways; namely, telescopic pancreatojejunostomy (PJ), ducto-mucosal Wirsungo jejunostomy (WJ), and Peng's variant of the telescopic technique. Study Design: A descriptive study. Place and Duration of Study: Izmir Katip Celebi Universitesi Hospital, Turkey, from January 2011 to January 2018. Methodology: A total of 144 proximal pancreaticoduodenectomy procedures were performed at the study centre. Patients' data was obtained from the outpatient files and hospital information system, retrospectively; and divided into three groups according to the pancreatic anastomosis techniques. All three groups were compared in terms of eight parameters. Preoperative parameters were age, gender, and serum direct bilirubin values; whereas, postoperative parameters were pathology, pancreatic fistula, drain amylase, serum albumin value and early mortality. Results: All variables by anastomosis type belonging to three groups differed for fistula rates (p=0.384), pathology types (p=0.142), preoperative bilirubin (p=0.631) and postoperative albumin (p=0.516) levels, early mortality (p=0.242) parameters without reaching statistical significance (p>0.05); however, the low anastomosis leak rates in Peng's technique were remarkable. POPF (post-operative pancreatic fistula) developed in 34% patients under 60 years vs. 17.6% patients over 60 years of age (p=0.029); and 13.7% females vs. 29.9% of male patients (p=0.032). Conclusion: No factors other than age and gender were found to be significant alone in the development of pancreatic fistula after proximal pancreaticoduodenectomy. Key Words: Postoperative pancreatic fistula, Pancreaticoduodenectomy, Pancreatojejunostomy, Telescopic pancreatojejunostomy (PJ), Ducto-mucosal Wirsungo jejunostomy (WJ), Peng's telescopic technique.