Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy Kristin Heeger*, Volker Fendrich, Jens Waldmann, Peter Langer, Veit Kanngießer, Detlef Klaus Bartsch Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043 Marburg, Germany article info Article history: Received 20 December 2012 Received in revised form 10 March 2013 Accepted 11 March 2013 Available online 10 May 2013 Keywords: Pancreaticoduodenectomy Pancreatogastrostomy Pancreaticojejunostomy Pancreatic fistula abstract Background and Purpose: A 2011 metaanalysis demonstrated no difference in postoperative complications between pancreatogastrostomy and pancreaticojejunostomy after pan- creaticoduodenectomy with the limitation of heterogeneity among the analysed studies. The present study compares postoperative complications after duct-to-mucosa pan- creaticojejunostomy with a modified binding purse-string-mattress sutures pan- creatogastrostomy in a teaching hospital. Methods: One-hundred consecutive pancreaticoduodenectomies were reconstructed either by pancreaticojejunostomy (n ¼ 50, 2004e2008) or modified pancreatogastrostomy (n ¼ 50, 2008e2011). Prospective patients’ data was retrospectively analysed for postoperative complications. Main findings: Complications occurred significantly less after modified pancreatogas- trostomy compared to pancreaticojejunostomy ( p ¼ 0.016). This was mainly due to a significantly lower rate of pancreatic fistula ( p ¼ 0.029), especially a lower rate of clinically relevant B and C fistulas ( p ¼ 0.011). In particular, the fistula rate was reduced in patients with a soft, non-fibrotic pancreas ( p ¼ 0.0231). Postoperative mortality was also lower after modified pancreatogastrostomy ( p ¼ 0.042). Uni- and multivariate analyses revealed a soft, non-fibrotic pancreatic texture (odds ratio 5.4, p ¼ 0.028), a non-dilatated pancreatic duct ( p ¼ 0.047) and pancreaticojejunostomy (odds ratio 10.7, p ¼ 0.026) as independent, negative factors for pancreatic fistula. Conclusion: In a teaching hospital, modified pancreatogastrostomy seems to be superior to pancreaticojejunostomy regarding pancreatic fistula, especially in patients with a soft, non-fibrotic pancreas and/or a small duct. An ongoing prospective randomised multicentre trial (RECOPANC) might confirm these results. ª 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: þ49 6421 5869775; fax: þ49 6421 5868995. E-mail address: dietzel@med.uni-marburg.de (K. Heeger). Available online at www.sciencedirect.com ScienceDirect The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland www.thesurgeon.net the surgeon 11 (2013) 246 e252 1479-666X/$ e see front matter ª 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.surge.2013.03.003