Abstract
Purpose: To investigate risk factors for late acute remnant pancreatitis after pancreatoduodenectomy (PD), we propose using the suture pitch calculated by the diameter of the main pancreatic duct and the number of sutures in the pancreatic duct-to-mucosa anastomosis.
Methods: This study included 142 patients who underwent elective PD. The suture pitch was calculated using the following formula: main pancreatic duct size × π ÷ number of sutures. Late acute pancreatitis was defined as acute pancreatitis that occurred >30 days after PD. We retrospectively evaluated clinical parameters to identify predictors of late acute remnant pancreatitis.
Results: Late acute remnant pancreatitis occurred in seven patients, and the 5- and 10-year cumulative incidence rates were 8.5% and 12.7%, respectively. A narrow suture pitch was significantly associated with male sex (p=0.037), younger age (p=0.003), a soft pancreas (p<0.001), a narrow pancreatic duct stent (p<0.001), a narrow main pancreatic duct (p<0.001), and late acute remnant pancreatitis (p=0.006). In the multivariate analysis, a narrow suture pitch was a significant independent risk factor for late acute remnant pancreatitis (p=0.041), but not for postoperative pancreatic fistula (p=0.106).
Conclusion: To prevent late acute remnant pancreatitis, the pancreatic duct-to-mucosa anastomosis should not be sutured too tightly. (196 words)