Isolated R oux‐en‐ Y anastomosis of the pancreatic stump in a duct‐to‐mucosa fashion in patients with distal pancreatectomy with en‐bloc celiac axis resection

Background A pancreatic fistula is one of the most serious complications in distal pancreatectomy with en bloc celiac axis resection ( DP‐CAR ), because the pancreatic transection is performed on the right side of the portal vein, which results in a large cross‐section surface, and because post‐pancreatectomy hemorrhage is hard to treat by interventional radiology. Therefore, a procedure to decrease the incidence of postoperative pancreatic fistula is urgently needed. Methods Twenty‐six consecutive patients who underwent DP‐CAR between A pril 2008 and A ugust 2012 were reviewed retrospectively. The first 13 consecutive patients underwent DP‐CAR with no anastomosis, and the subsequent 13 consecutive patients were treated with R oux‐en‐ Y pancreaticojejunostomy ( PJ ) in a duct‐to‐mucosa fashion. Results Extremely high amylase levels (>4000 IU/l) of all drainage fluid specimens on postoperative day ( POD ) 1, 3 and 4 were detected more frequently in cases with no anastomosis ( n  = 7) compared to those with PJ ( n  = 1) ( P  = 0.056). Conclusion The incidence of grade B / C pancreatic fistulas was 15.4% in cases with isolated R oux‐en‐ Y anastomosis of the pancreatic stump performed in a duct‐to‐mucosa fashion, and we are currently examining whether this anastomosis method reduces the pancreatic fistula rate in a multicenter, randomized controlled trial for distal pancreatectomy patients ( C linical T rials.gov NCT 01384617).