Safety and Efficacy of Double-Layer Pancreaticojejunostomy With a Wide Jejunal Opening: Initial Experience From a Consecutive Case Series

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.