Case Control Study
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World J Gastrointest Surg. Jun 27, 2025; 17(6): 104652
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.104652
Comparison of three reconstruction techniques performed after pancreaticoduodenectomy: Using external, internal, or no stent
Carlos Jiménez-Romero, Alejandro Marcacuzco-Quinto, Oscar Caso-Maestro, Laura Alonso, Clara Fernández-Fernández, Iago Justo
Carlos Jiménez-Romero, Oscar Caso-Maestro, Clara Fernández-Fernández, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, “12 de Octubre” University Hospital, Madrid 28041, Spain
Alejandro Marcacuzco-Quinto, Laura Alonso, Iago Justo, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital, Madrid 28045, Spain
Author contributions: Jiménez-Romero C and Justo I designed the research, extracted the data, performed the data analysis, wrote the paper and reviewed the manuscript validation; Fernández-Fernández C, Caso-Maestro O, Marcacuzco-Quinto A, collected the data and prepared figures and tables; Jiménez-Romero C, Marcacuzco-Quinto A, Caso-Maestro O, Alonso L, Fernández-Fernández C, Justo I read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the “12 de Octubre” University Hospital Institution Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were collected after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and data set is available from the corresponding author if required.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Iago Justo, PhD, Doctor, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital, 6th floor. Outpatient Clinic. Ctra Andalucía km 5,4, Madrid 28045, Spain. ijusto@ucm.es
Received: December 27, 2024
Revised: March 13, 2025
Accepted: May 6, 2025
Published online: June 27, 2025
Processing time: 154 Days and 18.6 Hours
Abstract
BACKGROUND

Postoperative pancreatic fistula (POPF) is the most frequent cause of morbimortality after pancreaticoduodenectomy, but the best technique to use to prevent its development is unclear. The choice of drainage method external duct stent (EDS), internal duct stent (IDS), or non-ductal stent (NDS) is also controversial.

AIM

To compare the three groups (EDS, IDS and NDS), analyzing the patient characteristics, perioperative examinations and survival.

METHODS

Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020, were divided into the EDS, IDS and NDS groups.

RESULTS

Of the 244 patients included, 129 were in the EDS group, 71 in the IDS group, and 44 in the NDS group. Except for preoperative pancreatitis in the NDS patients, comorbidities were similar among the groups. Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas (P < 0.001). A lower rate of grade C POPF was observed in the EDS (1.6%) compared to the NDS (9.1%) and IDS group (14.1%) (P = 0.009). The groups showed similar findings for delayed gastric emptying, postoperative hemorrhage, reoperation, and 5-year survivals. Ninety-day mortality rate was significantly higher in the IDS group (5.6%) compared to the EDS (1.6%) and NDS (4.5%) groups (P = 0.046). Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF (P = 0.034), and 90-day mortality (P = 0.018). Additionally, a Wirsung duct diameter < 3 mm was the only risk factor for grade B/C POPF (P = 0.001), and 90-day mortality (P = 0.031).

CONCLUSION

The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality, and the Wirsung duct < 3 mm was a risk factor for grade B/C POPF and 90-day mortality.

Keywords: Pancreaticoduodenectomy; Pancreaticojejunostomy; External duct stent; Internal duct stent; No ductal stent; Postoperative pancreatic fistula

Core Tip: Postoperative pancreatic fistula is the most frequent cause of morbimortality after pancreaticoduodenectomy. Controversy exists concerning the best reconstruction technique to reduce morbimortality. Comparison of the three techniques of Wirsung duct drainage (external, internal or non-ductal stent) after pancreaticoduodenectomy demonstrated that external stent was a protective factor for grade B/C postoperative pancreatic fistula and 90-day mortality, and the Wirsung duct < 3 mm was a risk factor for grade B/C postoperative pancreatic fistula and 90-day mortality.