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Extended pancreatic transection for secure pancreatic reconstruction during pancreaticoduodenectomy
Ann Hepatobiliary Pancreat Surg 2017 Aug;21(3):138-45
Published online August 31, 2017
Copyright © 2017 Ann Hepatobiliary Pancreat Surg.

Eun-Kyoung Jwa, and Shin Hwang

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Received July 17, 2017; Revised August 11, 2017; Accepted July 17, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Pancreaticoduodenectomy (PD) is associated with various surgical complications including healing failure of the pancreaticojejunostomy (PJ). This study intended to ensure blood supply to the pancreatic stump through extended pancreatic transection (EPT). Methods: This study assessed whether EPT reduces PJ-associated complica-tions and whether EPT is harmful on the remnant pancreatic function. The EPT group included 19 patients undergoing PD, pylorus-preserving PD (PPPD) or hepatopancreaticoduodenectomy. The propensity score matched control group included 45 patients who had undergone PPPD. Pancreatic transection was performed at the level of the celiac axis in the EPT group, by which the pancreatic body was additionally removed by 3 cm in length comparing with the conven-tional pancreatic transection. Results: A small invagination fissure suspected as the embryonic fusion site was identified at the ventro-caudal edge of the pancreatic body in all patients undergoing EPT. A sizable fissure permitting easy separation of the pancreatic parenchyma was identified in 15 of 19 patients (78.9%). The incidence of significant post-operative pancreatic fistula was significantly lower in the EPT group than in the control group (p=0.047). There was no significant increase in the postoperative de novo diabetes mellitus in EPT group (p=0.60). Conclusions: The EPT technique contributes to the prevention of major pancreatic fistula without impairing remnant pancreatic function. EPT is feasible for routine clinical application or at least in patients with any known risk of PJ leak. (Ann Hepatobiliary Pancreat Surg 2017;21:138-145)
Keywords : Pancreatic leak; Complication; Pancreaticojejunostomy