A new guideline to reduce postoperative morbidity after pancreaticoduodenectomy

Sohei Satoi, Hideyoshi Toyokawa, Hiroaki Yanagimoto, Tomohisa Yamamoto, Jun Yamao, Songtae Kim, Yoichi Matsui, Soichiro Takai, Hynek Mergental, Yasuo Kamiyama

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)


OBJECTIVES: Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in perioperative managements of pancreaticoduodenectomy.

METHODS: Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In June 2004, the following new departmental guidelines were introduced: (1) modified Kakita method of pancreaticojejunostomy, (2) omental wrapping, (3) early removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were determined.

RESULTS: Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = 0.019). Occurrence of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P = 0.0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = 0.0133). Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed gastric emptying.

CONCLUSIONS: The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been reduced because of the introduction of a new guideline.

Original languageEnglish
Pages (from-to)128-33
Number of pages6
Issue number2
Publication statusPublished - Aug 2008


  • Aged
  • Aged, 80 and over
  • Female
  • Gastric Emptying
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Morbidity
  • Pancreatic Fistula
  • Pancreaticoduodenectomy
  • Postoperative Complications
  • Time Factors


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