Functional, Biological, and Radiological Evaluation of the Pancreaticojejunal Anastomosis 1 Year After Pancreatoduodenectomy: a Prospective Study

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2023 Aug 22

PMID 37606699

Authors

Gaetan-Romain Joliat

Pierre Allemann

Ismail Labgaa

Nicolas Demartines

Naik Vietti Violi

Sabine Schmidt

Markus Schafer

Affiliations

Soon will be listed here.

Abstract

Purpose: This prospective study aimed to analyze the functional, biological, and radiological aspects of the pancreatic anastomosis 1 year after pancreatoduodenectomy (PD).

Methods: From 2016 to 2019, patients with PD indication were screened. Questionnaires about pancreas insufficiency, fecal elastase tests, and magnetic resonance imaging (MRI) were performed before and 1 year after PD.

Results: Twenty patients were prospectively included. The only difference between pre- and postoperative questionnaires was constipation (less frequent 1 year after PD). Median pre- and postoperative fecal elastase levels were 96 μg/g (IQR 15-196, normal value > 200) and 15 μg/g (IQR 15-26, p = 0.042). There were no significant differences in terms of main pancreatic duct (MPD) size (4, IQR 3-5 vs. 4 mm, IQR 3-5, p = 0.892), border regularity, stenosis, visibility, image improvement, and secondary pancreatic duct dilation before and after secretin injection. All patients but one (2 refused and 2 were lost to follow-up, 15/16, 94%) had a patent pancreaticojejunal anastomosis on 1-year MRI.

Conclusion: Although median 1-year fecal elastase was significantly lower than preoperatively, suggesting that exocrine secretion was altered, the anatomical outcome as assessed by MRI was excellent showing high patency rate (15/16, 94%) at 1 year. This emphasizes the difference between anatomy and function.

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