Surgery
June 26, 2026 · via Europe PMC
Comparison of anastomotic patency and remnant pancreatic function between invagination and duct-to-mucosa pancreaticojejunostomy: A follow-up study of a randomized trial.
Ojio H, Natsume S, Shimizu Y, +6 more, Abe T.
AI summary — for doctors, generated from the abstract only
Long-term anastomotic patency and remnant pancreatic function were similar after invagination versus duct-to-mucosa pancreaticojejunostomy.
What was studied
A retrospective follow-up of 120 patients from a prior randomized trial (2011-2015) comparing invagination and duct-to-mucosa pancreaticojejunostomy after pancreatoduodenectomy, assessing duct dilatation, stricture, pancreatic volume, fatty liver and diabetes.
Key findings
- Remnant duct dilatation 18.6% invagination vs 9.8% duct-to-mucosa (P = .262)
- 5-year cumulative incidence of dilatation 19.9% vs 13.4% (P = .356)
- Benign anastomotic stricture in 9 patients (5 vs 4), not significantly different
- Some patients with duct dilatation developed pancreatic pain or pancreatolithiasis
- Pancreatic volume, fatty liver and type 2 diabetes incidence were similar
Clinical relevance
These data suggest the choice between these anastomotic techniques may not substantially affect long-term patency or function, though the study was not powered for these outcomes.
Who should care
Limitations
Retrospective secondary analysis of a trial designed for a different endpoint, with modest sample size and surrogate markers.
Invagination and duct-to-mucosa pancreaticojejunostomy showed comparable long-term outcomes.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
While invagination pancreaticojejunostomy may reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy, its long-term impact on anastomotic patency and remnant pancreatic function remains unclear.
Aim
To compare long-term anastomotic patency and remnant pancreatic function between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy after pancreatoduodenectomy.
Methods
In this retrospective study, we reviewed data from 120 patients from a previous randomized trial comparing the incidence of pancreatic fistula between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy (UMIN000005890; 2011-2015). Remnant pancreatic duct dilatation and anastomotic stricture were evaluated as surrogate markers for late-term anastomotic patency. Benign anastomotic stricture was defined as an endoscopically confirmed narrowing of the anastomosis. Remnant pancreatic volume, fatty liver disease, and new-onset or worsening type 2 diabetes mellitus were evaluated as markers of exocrine and endocrine function.
Results
The frequency of benign remnant pancreatic duct dilatation was 18.6% in patients who underwent invagination pancreaticojejunostomy and 9.8% in those who underwent duct-to-mucosa pancreaticojejunostomy (P = .262). The 3- and 5-year cumulative incidences were 9.3% and 19.9%, respectively, for invagination pancreaticojejunostomy versus 9.5% and 13.4%, respectively, for duct-to-mucosa pancreaticojejunostomy (P = .356). Benign anastomotic stricture occurred in 9 patients (invagination pancreaticojejunostomy: n = 5; duct-to-mucosa pancreaticojejunostomy: n = 4), with no significant difference between groups. Among those with remnant pancreatic duct dilatation, some developed pancreatic pain or pancreatolithiasis, whereas no such symptoms were seen in patients without remnant pancreatic duct dilatation. Remnant pancreatic volume, fatty liver disease, and the incidence of type 2 diabetes mellitus were similar between groups.
Conclusion
Radiologic suspicion of impaired patency and pancreatic functions was comparable between invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy. Although remnant pancreatic duct dilatation occurred occasionally, its clinical impact is likely to be relatively minimal.
DOI
10.1016/j.surg.2026.110421
PMID
42508089
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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