Conventional Versus Binding Pancreaticojejunostomy After Pancreaticoduodenectomy: A Prospective Randomized Trial

Dramatic improvement in operative mortality has expanded the indications for pancreaticoduodenectomy from periampullary tumors, to pancreatic head cancer, benign neoplasms and other non-neoplastic conditions such as chronic pancreatitis.1 However, postoperative morbidity remains high even in large series.2–4 Leakage from pancreatic anastomosis remains the single most important cause of morbidity, and it also contributes significantly to prolonged hospitalization and mortality.1 The incidence of pancreatic leakage varies greatly in different reports because of the various definitions used. In a review by Bassi et al,5 the incidence of pancreatic leakage ranged between 9.9% and 28.5%, and different definitions of pancreatic leakage were applied with high statistical differences between them. Thus, it is important to have the same definition of pancreatic leakage before any series of patients can be compared. Many factors have been identified that are associated with a significantly higher incidence of pancreatic leakage after pancreaticoduodenectomy.1 The surgeon has been shown to be one of the most, if not the most, important factor in the prevention of pancreatic anastomosis leakage,6,7 and it is logical to relate operative morbidity and mortality to the surgical volume handled.8 The best technique in pancreatic anastomosis is still debated. The technique most commonly employed after pancreaticoduodenectomy is pancreaticojejunostomy. We established a new pancreaticojejunostomy anastomosis technique, binding pancreaticojejunostomy with a leakage rate of 0%.9,10 This prospective randomized study aimed to compare the new binding with the conventional pancreaticojejunostomy using a predetermined definition, and controlling the known compounding factors, of pancreatic leakage after pancreaticoduodenectomy.