American Surgical Association
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External Drainage of Pancreatic Duct With A Stent To Reduce Leakage Rate of Pancreaticojejunostomy After Pancreaticoduodenectomy: A Prospective Randomized Trial
Ronnie T Poon*, Sheung-Tat Fan*, Chung-Mau Lo*, Kelvin K Ng*, Wai-Key Yuen*, Chun Yeung*, John Wong
The University of Hong Kong, Hong Kong, China

OBJECTIVE(S): Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreatic duct with a stent has been shown to reduce pancreatic fistula rate of pancreaticojejunostomy in a few retrospective or prospective nonrandomized studies, but no randomized controlled trial has been reported thus far. This single-center prospective randomized trial compared the results of pancreaticoduodenectomy with external drainage stent versus no stent for pancreaticojejunal anastomosis.
METHODS: A total of 120 patients undergoing pancreaticoduodenectomy with end-to-side pancreaticojejunal anastomosis were randomized to have either an external stent inserted across the anastomosis to drain the pancreatic duct (n=60) or no stent (n=60). Duct-to-mucosa anastomosis was performed in all cases.
RESULTS: The two groups were comparable in demographic data, underlying pathologies, pancreatic consistency and duct diameter. Stented group had a significantly lower pancreatic fistula rate compared with nonstented group (6.7% vs. 20%, p=0.032). Radiological or surgical intervention for pancreatic fistula was required in 1 patient in the stented group and 4 patients in the nonstented group. There were no significant differences in overall morbidity (31.7% vs. 38.3%, p=0.444) and hospital mortality (1.7% vs. 5%, p=0.309). Two patients in the nonstented group and none in the stented group died of pancreatic fistula. Hospital stay was significantly shorter in the stented group (mean 17 vs. 23 days, p=0.039). On multivariate analysis, pancreatic duct diameter <3 mm and no stenting were significant risk factors of pancreatic fistula.
CONCLUSIONS: External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy.

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