Introduction: Postoperative pancreatic fistula (POPF) remains the most significant complication following pancreaticoduodenectomy. The duct-to-mucosa (DTM) technique has gained attention for its potential to reduce POPF rates. While most published techniques involve a small jejunal opening (1 cm), this study evaluates the safety and feasibility of wide jejunal opening (approximately 4 cm) anastomosis in a consecutive case series. Method: This retrospective analysis included 12 consecutive patients who underwent pancreaticoduodenectomy with double-layer DTM pancreaticojejunostomy using a wide jejunal opening at our institution, between January 2017 and August 2024. Outcome related to clinically relevant postoperative pancreatic fistula (CR-POPF), drain fluid amylase levels, delayed gastric emptying (DGE), operative time, hospital stay, and complications were analyzed. Results: The mean patient age was 59.8 ± 10.5 years, with a median pancreatic duct diameter of 3.5 mm (range: 2-6 mm). The mean anastomosis time was 51.25 ± 7.11 (range: 40-60) minutes. No patient developed CR-POPF. DGE occurred in 10 patients (83.3%), predominantly grade C in seven (58.3%). Overall morbidity was 41.7% (5/12). Conclusion: Although this study has a limited number of patients, it emphasizes the safety of double-layer DTM pancreaticojejunostomy with a wide jejunal opening. The technique's complexity and longer anastomosis time must be balanced against potential benefits in challenging scenarios such as small duct diameter or soft pancreas.
Kaushal Yadav (Thu,) studied this question.