Tight Anastomosis of the Pancreatojejunostomy During Pancreatoduodenectomy May Cause Late Acute Pancreatitis.

BACKGROUND/AIM: To investigate risk factors of late acute remnant pancreatitis after pancreatoduodenectomy (PD), we propose the use of a suturing pitch calculated based on the diameter of the main pancreatic duct and the number of sutures used in the pancreatic duct-to-mucosa anastomosis. This study aimed to determine whether the suturing pitch can predict late acute pancreatitis following PD.

PATIENTS AND

METHODS

This study included 142 patients who underwent elective PD. The suturing pitch was defined as the distance between the ligations of the duct-to-mucosa anastomosis of the pancreatojejunostomy. It was calculated using the formula: main pancreatic duct size × π ÷ suturing number. Late acute pancreatitis was defined as acute pancreatitis occurring more than 30 days after PD. We retrospectively evaluated clinical parameters, including the suturing pitch, to identify predictors of late acute remnant pancreatitis.

RESULTS

Late acute remnant pancreatitis occurred in seven patients, and the 5-year and 10-year cumulative incidence rates were 8.5% and 12.7%, respectively. A narrow suturing pitch was significantly associated with male sex (p=0.037), younger age (p=0.003), soft pancreas (p<0.001), narrow pancreatic duct stent size (p<0.001), narrow main pancreatic duct size (p<0.001), and the occurrence of late acute remnant pancreatis (p=0.006). In multivariate analysis, the narrow suturing pitch was a significant and independent risk factor of late acute remnant pancreatitis (p=0.041), but not of postoperative pancreatic fistula (p=0.106).

CONCLUSION

To prevent late acute remnant pancreatitis, the pancreatic duct-to-mucosa anastomosis should not be sutured too tightly.