Technical and Mechanical Risk Factors for Postoperative Pancreatic Fistula in Pancreaticojejunostomy

Background/Aims: The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy. Methodology: Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non-POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 us. 6-0) for DMA. Results: The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0 +/- 1.4/4.2 +/- 2.0mm, total number of sutures for DMA was 6.8 +/- 1.6/7.0 +/- 2.8, whereas mean interval between sutures was 1.4 +/- 0.5/2.1 +/- 1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF. Conclusions: The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.