Evaluation of surgical outcomes between isolated hepaticojejunostomy reconstructions versus conventional reconstruction after pancreaticoduodenectomy

Background
Pancreaticoduodenectomy (PD) is one of the major and challenging abdominal operations, associated with morbidity rate 40–50% and mortality rate less than 5%.
Aim
To evaluate surgical outcomes between isolated hepaticojejunostomy reconstruction after PD versus conventional reconstruction after PD as regards postoperative morbidity and mortality.
Patients and methods
This is a prospective cohort study conducted at Ain Shams University Hospitals, in the period from October 2016 to May 2020. Sixty patients with malignant masses in pancreatic head, periampullary, or duodenum, were recruited for this study. Ethical approval was obtained from Al Demerdash ethical committee.
Results
Our study included 60 patients who underwent PD, our mean age was 57.22±10.07 years (40–82 years). In group I (the conventional group), five (16.7%) cases had pancreatic fistula, while group II (isolated hepaticojejunostomy) had only one (3.3%) case, although higher incidence in group I of postoperative pancreatic fistula but value 0.085. Group I had seven (23.3%) cases, while group II had no cases of biliary reflux with value 0.005. Delayed gastric emptying in group I had four (13.3%) cases, while group II had three (10%) cases with value 0.68. The mean operative blood loss was 523.00±92.14 ml (300–700 ml). The mean hospital stay was 10.14±2.28 days (7–18). The overall percentage of wound complications was 23.3%. The overall mortality was 1.7%.
Conclusion
Isolated hepaticojejunostomy reconstruction after PD associated with a low rate of postoperative pancreatic fistula and no biliary gastric reflux, but needs longer time than conventional reconstruction after PD. Further studies are needed to confirm the results.