A comparison: pair-watch suturing and conventional duct-to-mucosa pancreaticojejunostomy anastomosis techniques

BACKGROUND: Morbidity and mortality after pancreaticoduodenectomy have been associated with postoperative pancreatic fistula. Pancre- atic anastomosis is challenging for most surgeons, and there is no universal or standardized technique. This study aimed to compare the inci- dence of postoperative pancreatic fistula between the pair-watch suturing technique and duct-to-mucosa pancreaticojejunostomy anastomosis technique. Additionally, postoperative pancreatic fistula risk factors were determined.METHODS: This retrospective cohort analysis included 71 patients who underwent a pancreaticoduodenectomy between January 2009 and Oc- tober 2018 at Bhumibol Adulyadej Hospital, a tertiary hospital of the Royal Thai Air Force. A standardized case report form was used to obtain the required information from medical records.RESULTS: There was no significant difference in the incidence of postoperative pancreatic fistula between the pair-watch suturing technique (N.=7; 30.4%) and duct-to-mucosa pancreaticojejunostomy (N.=9; 18.7%) groups. The tumor site (P=0.001) and pancreas density on computed tomography without contrast (P=0.002) were significantly different between the groups. Age & GE;60 years (odds ratio, 11.07; 95% confidence interval, 1.14-107.36; P=0.038) and pancreatic body mass/duct size ratio (odds ratio, 1.41; 95% confidence interval, 1.04-1.91; P=0.029) were identified as significant risk factors for postoperative pancreatic fistula.CONCLUSIONS: The present study identified postoperative pancreatic fistula risk factors, including age and pancreatic body mass/duct size ra- tio. The surgical techniques, i.e., pair-watch suturing technique and duct-to-mucosa pancreaticojejunostomy anastomosis, were not significantly associated with postoperative pancreatic fistula incidence.