Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage

Background. A soft pancreas with a,nain pancreatic duct (MPD) with normal diameter has been considered a high risk for pancreatic anastomotic leakage because of a relatively high output of pancreatic juice, but data are lacking. Methods. An attempt was made to assess the relationship, between the consistency of the pancreas, MPD diameter, pancreatic juice output, and pancreatic leakage after partial pancreatoduodenectomy. The pancreatic parenchyma was classified as of soft, intermediate, and hard consistency in 70 consecutive patients undergoing operation (groups 1, 2, and 3, respectively) by one surgeon. The MPD diameter was determined by means of endoscopic pancreatography or abdominal ultrasonography. Pancreatic juice output was measured for 21 days after operation by Ising a catheter inserted into the MPD. Anastomotic leakage was identified radiologically by using contrast medium. Results. The mean (SD) pancreatic juice output) during a period of 10 days (postoperative days 5 to 14) was 1554 (1073) mi in group 1 (n = 29), 1513 (1060) mi in group 2 (n = 13), and 187 (220) mi in group 3 (n = 28) (groups I and 2 versus group 3, p < 0.0001). The MPD diameter was 3.0 (1.6) mm in group 1, 5.9 (2.5) mm in group 2, and 6.6 (2.6) mm in group 3 (group I versus groups 2 and 3, p = 0.0001). Anastomotic leaks occurred in four (14%) patients in group 1, three (23%) in group 2, and none In group 3 (p < 0.05). Conclusions. Patients with a pancreatic parenchyma with an intermediate or normal consistency produced more pancreatic juice and had a higher leak rate.