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Background: Pancreatico-enteric anastomosis failure has been the main cause of morbidity and mortality after pancreaticoduodenectomy. Methods: 78 pancreatico-enteric anastomosis failure (PEAF) patients of 403 Pancreaticoduodenectomy (PD) were included for this retrospective study. PEAF was defined by the presence of rich amylase (over 10,000 IU/L) in drainage fluid at postoperative day 5 to 7 and radiographic demonstration of the anastomotic breakdown and associated local fluid collection. The management was analysed by observation group (O group), intervention (I group) and surgery group (S group). Results: Preoperative clinical status of the PEAF group and non PEAF group was similar. Bile duct cancer was the highest risk subgroup of the PEAF (p=0.001) and the pancreatic adenocarcinoma showed the least risk for the PEAF (p<0.001). Among the 78 PEAF patients, 50 were managed as a conservative treatment, 15 patients were received radiologic intervention and 13 patients performed rescue surgery. Among these 3 subgroups, there was no statistical significance in the patient’s demographics, clinical status (ASA classification), surgical factors and disease nature. However, mortality was significantly higher in the S group (p<0.001). The mortality cases were developed in O and S group 1 and 6 patients, respectively. Surgical procedures in S group were completion total pancreatectomy with or without splenectomy (n=12) and pancreatectomy preserving spleen in 4 (28.6%). Pancreatico-gastrostomy repair and Roux-en-Y pancreatico-jejeunostomy reconstruction were performed each case, respectively. Conclusions: Proper drainage catheter indwelling during the pancreatico-duodenectomy or postoperative radiological intervention can effectively manage the pancreatico-enteric anastomosis failure without surgical interventional treatment.

Single institute experience of pancreatico-enteric anastomosis failure after pancreaticoduodenectomy