CONTROLLED PROSPECTIVE CLINICAL TRIALS Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study Vassilios Smyrniotis & Nikolaos Arkadopoulos & Maria A. Kyriazi & Michael Derpapas & Theodosios Theodosopoulos & Constantinos Gennatas & Agathi Kondi-Paphiti & Ioannis Vassiliou Received: 24 September 2009 / Accepted: 3 December 2009 / Published online: 16 January 2010 # Springer-Verlag 2010 Abstract Aim This study’ s aim is to evaluate the effectiveness of using an internal stent when fashioning a duct-to-mucosa pancreatojejunostomy on preventing pancreatic fistula formation, as well as on the overall outcome for patients undergoing pancreaticoduodenectomy. Materials and methods Between January 2000 and December 2008, 82 consecutive patients underwent pancreaticoduo- denectomy and duct-to-mucosa pancreaticojejunostomy in an isolated jejunal loop, either with or without the aid of an internal stent. The allocation of the patients into group A (n =41, stented anastomosis) and group B (n =41, unstented anastomosis) was performed in a strictly alternating way. No statistically significant differences were identified between the two groups regarding age, sex, operative time, intraoperative pathological findings, and comorbidities. The two groups were compared regarding the rate of pancreatic fistula formation, postoperative complications, and hospital stay. Results In group A, pancreatic fistula formation rate was 4.9%; overall morbidity reached 30%; and hospital stay duration was 13±4 days. In group B, pancreatic fistula formation rate was 2.4%; overall morbidity was 26%; and hospital stay duration extended to 14±5. According to Clavien’ s classification, the severity of surgical complica- tions was designated as follows: for group A, 56% of the Author contributions Smyrniotis V: chief surgeon, designed, drafted, and reviewed the manuscript Arkadopoulos N: assisted in the operations and performed critical revisions of the manuscript Kyriazi MA: assisted in designing and drafting the manuscript Derpapas M: participated in the acquisition of data and preparation of the manuscript Theodosopoulos T: contributed substantially to manuscript conception and design Gennatas C: performed postoperative follow-up of patients Kondi-Paphiti: performed histopathological analysis of specimens Vassiliou J: assisted in the operations, responsible for critical revision of scientific content V. Smyrniotis 5th Department of Surgery, Areteion Hospital, University of Athens Medical School, Athens, Greece N. Arkadopoulos : M. A. Kyriazi (*) : M. Derpapas : T. Theodosopoulos : I. Vassiliou 2nd Department of Surgery, Areteion Hospital, University of Athens Medical School, 17 Efpatorias Str, Athens, Greece e-mail: mkyriazi@otenet.gr A. Kondi-Paphiti Department of Pathology, Areteion Hospital, University of Athens Medical School, Athens, Greece C. Gennatas Department of Oncology, Areteion Hospital, University of Athens Medical School, Athens, Greece Langenbecks Arch Surg (2010) 395:195–200 DOI 10.1007/s00423-009-0585-6