A modified single/double-layer duct-to-mucosa pancreaticojejunostomy reduces pancreatic fistula after pancreaticoduodenectomy based on 681 cases in a single center

Abstract

Introduction: Pancreaticoduodenectomy (PD) is a technically challenging surgery requiring longer period of recovery post operatively. The introduction of ERAS after PD has been debatable with no conclusive success. This study aims to compare early post-operative outcome of PD after implementation of ERAS protocol with previous conservative postoperative care. Method: 81 patients who underwent PD in UKMMC were recruited from Jan 2011 to April 2015. The control group were patients (n = 47) operated before January 2013 (pre-ERAS) while the case group were patients who were operated after implementation of ERAS protocol (n = 34). Demographic, pre-operative clinical data and early postoperative outcome are collected retrospectively. Results: The median length of stay of the post ERAS group were 11.7 days compared to 15.4 days in the pre ERAS group (p = 0.002). The rate of post-operative morbidity such as delayed gastric emptying, post operative pancreatic fistula, and post pancreatic haemorrhage were similar. There were no difference with regards to relaparotomy, readmission and mortality rate. The postoperative complications such as deep vein thrombosis, pulmonary embolism and pneumonia is significantly lower from 27.7% in the pre-ERAS group to 5.9% in the post ERAS group (p = 0.019). Conclusions: This study provides conclusive results of ERAS benefit with regards to recovery and a significant reduction of length of stay without affecting patient morbidity, mortality and readmission rate. It also proves to be the best management in reducing postoperative complications.