Binding and interlocking pancreaticojejunostomy vs duct to mucosa pancreaticojejunostomy: A retrospective cohort study

Table 1 Patient demographics and baseline characteristics, n (%)

Preoperative variables	Technique		P value
	DMPJ, n = 34	BIPJ, n = 33
Age, years	62 (57, 70)	66 (59, 73)	0.144
Gender, male	21 (62)	14 (42)	0.158
BMI, kg/m2	23.02 ± 2.89	21.80 ± 3.48	0.124
Hypertension, yes	12 (35)	14 (42)	0.549
Diabetes, yes	7 (21)	5 (15)	0.562
Preoperative biliary drainage, yes	0 (0)	2 (6)	0.239
Neoadjuvant therapy, yes	6 (18)	1 (3)	0.105
White blood cells, × 109/L	6.70 (5.03, 8.03)	6.40 (5.30, 7.60)	0.726
Hemoglobin, g/L	122 ± 24	122 ± 19	0.967
Aspartate aminotransferase, U/L	39 (20, 73)	32 (21, 85)	0.757
Alanine aminotransferase, U/L	33 (22, 60)	36 (24, 101)	0.309
Total bilirubin, μmol/L	15 (10, 64)	19 (13, 159)	0.229
Direct bilirubin, μmol/L	3 (2, 18)	2 (0, 88)	0.591
Blood creatinine, μmol/L	69 (57, 80)	61 (55, 72)	0.185
Blood urea nitrogen, mmol/L	4.39 (3.60, 5.95)	4.36 (3.35, 5.44)	0.580
Serum albumin, g/L	39.0 ± 4.4	36.9 ± 4.4	0.089
C-reactive protein	6.1 (2.5, 33.7)	7.7 (2.9, 25.8)	0.763

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy; BMI: Body mass index.

Table 2 Risk factors for pancreatic fistula, n (%)

Variables	Technique		P value
	DMPJ, n = 34	BIPJ, n = 33
Pancreatic texture of remnant pancreas			0.162
Soft	26 (76)	20 (61)
Hard	8 (24)	13 (39)
Main pancreatic duct size			0.393
≤ 3 mm	15 (44)	18 (55)
> 3 mm	19 (56)	15 (45)
Pancreatic fistula risk classification			0.447
A	6 (18.2)	5 (14.7)
B	7 (21.2)	3 (8.82)
C	9 (27.3)	14 (41.2)
D	11 (33.3)	12 (35.3)

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy.

Table 3 Operative outcomes, n (%)

Variables	Technique		P value
	DMPJ, n = 34	BIPJ, n = 33
Operative time, minutes	388 (341, 464)	340 (310, 350)	0.004
Intraoperative bleeding, mL	200 (200, 275)	200 (100, 200)	0.431
Red blood cell transfusion	100 (0, 400)	0 (0, 100)	0.062
Final pathological diagnosis			0.452
Pancreatic cancer	21 (62)	18 (55)
Neuroendocrine tumor	7 (21)	1 (3)
Ampullary neoplasm	1 (3)	5 (15)
Duodenal cancer	2 (6)	5 (15)
Intraductal papillary mucinous neoplasm	3 (9)	2 (6)
Pancreatic serous cystadenoma	0 (0)	1 (3)
Bile duct cancer	0 (0)	1 (3)

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy.

Table 4 Postoperative complications, n (%)

Variables	Technique		P value
	DMPJ, n = 34	BIPJ, n = 33
Pancreatic fistula			0.183
None	10 (29)	17 (52)
Biochemical leakage	7 (21)	6 (18)
Grade B	15 (44)	7 (21)
Grade C	2 (6)	3 (9)
Intra-abdominal hemorrhage, yes	2 (6)	3 (9)	0.673
Intraabdominal abscess, yes	1 (3)	1 (3)	1.000
Postoperative biliary fistula, yes	0 (0)	1 (3)	0.493
Postoperative chylous fistula, yes	6 (18)	1 (3)	0.105
Reoperation, yes	2 (6)	0 (0)	0.493
Postoperative hospital stay, days	18 (15, 27)	18 (14, 22)	0.400
Hospitalization costs, × 104 yuan	1223 (1009, 1519)	1028 (921, 1353)	0.071
Mortality within 30 days	0 (0)	0 (0)	1.000

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy.

Table 5 Subgroup analysis of main pancreatic duct size, n (%)

Variables	Main pancreatic duct size (≤ 3 mm), n = 33			Main pancreatic duct size (> 3 mm), n = 34
	DMPJ, n = 15	BIPJ, n = 18	P value	DMPJ, n = 19	BIPJ, n = 15	P value
Operative time, minutes	380 (330, 450)	340 (311, 345)	0.031	410 (345, 488)	340 (308, 403)	0.066
Intraoperative bleeding, mL	200 (150, 200)	200 (100, 200)	0.592	200 (200, 300)	200 (100, 350)	0.886
Red blood cell transfusion	200 (0, 450)	0 (0, 0)	0.003	0 (0, 390)	100 (0, 450)	0.752
Pancreatic fistula			0.817			0.090
None	4 (27)	8 (44)		6 (32)	9 (60)
Biochemical leakage	3 (20)	3 (17)		4 (21)	3 (20)
Grade B	7 (47)	6 (33)		8 (42)	1 (7)
Grade C	1 (7)	1 (6)		1 (5)	2 (13)
Intra-abdominal hemorrhage, yes	2 (13)	1 (6)	0.579	0 (0)	2 (13)	0.187
Intraabdominal abscess, yes	1 (7)	0 (0)	0.455	0 (0)	1 (7)	0.441
Postoperative biliary fistula, yes	0 (0)	1 (6)	1.000	0 (0)	0 (0)	1.000
Postoperative chylous fistula, yes	3 (20)	0 (0)	0.083	3 (16)	1 (7)	0.613
Reoperation, yes	1 (7)	0 (0)	0.455	1 (5)	0 (0)	1.000
Postoperative hospital stay, days	18 (15, 29)	18 (13, 24)	0.246	17 (16, 23)	18 (16, 21)	0.945

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy.

Table 6 Subgroup analysis of pancreatic texture, n (%)

Variables	Pancreatic texture of remnant pancreas (soft), n = 46			Pancreatic texture of remnant pancreas (hard), n = 21
	DMPJ, n = 26	BIPJ, n = 20	P value	DMPJ, n = 8	BIPJ, n = 13	P value
Operative time, minutes	403 (351, 469)	335 (300, 345)	0.001	365 (301, 421)	340 (325, 395)	0.856
Intraoperative bleeding, mL	200 (200, 300)	100 (100, 200)	0.023	200 (50, 200)	200 (200, 300)	0.049
Red blood cell transfusion	100 (0, 400)	0 (0, 100)	0.095	100 (0, 325)	0 (0, 0)	0.365
Pancreatic fistula			0.817			0.090
None	6 (23)	12 (60)		4 (50)	5 (38)
Biochemical leakage	5 (19)	2 (10)		2 (25)	4 (31)
Grade B	13 (50)	4 (20)		2 (25)	3 (23)
Grade C	2 (8)	2 (10)		0 (0)	1 (8)
Intra-abdominal hemorrhage, yes	2 (8)	2 (10)	1.000	0 (0)	1 (8)	1.000
Intraabdominal abscess, yes	1 (4)	1 (5)	1.000	0 (0)	0 (0)	1.000
Postoperative biliary fistula, yes	0 (0)	1 (5)	0.435	0 (0)	0 (0)	1.000
Postoperative chylous fistula, yes	4 (15)	1 (5)	0.369	2 (25)	0 (0)	0.133
Reoperation, yes	2 (8)	0 (0)	0.498	0 (0)	0 (0)	1.000
Postoperative hospital stay, days	19 (16, 32)	18 (16, 25)	0.498	17.0 (14.8, 18.0)	17.0 (13.0, 21.0)	0.942

DMPJ: Duct to mucosa pancreaticojejunostomy; BIPJ: Binding and interlocking pancreaticojejunostomy.