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September 6, 2026Langenbeck s Archives of SurgeryOpen Access

Pancreaticojejunostomy and clinically relevant pancreatic fistula: a modified dunking technique and single-center experience

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Authors

EPEmily PapaiDCDavid CyrJFJordan Fredette

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Overview

Retrospective cohort study reveals lower unadjusted pancreatic fistula rates with modified dunking pancreaticojejunostomy, suggesting confounding factors like gland texture influence the outcome.

Key Points

  • To compare the incidence of clinically relevant postoperative pancreatic fistula between a modified dunking pancreaticojejunostomy technique and standard pancreaticoduodenectomy reconstruction.
  • Retrospective single-center study analyzing 367 patients undergoing pancreatoduodenectomy with either a modified dunking technique (N=208) or standard technique (N=159).
  • Evaluated clinically relevant postoperative pancreatic fistula (CR-POPF) using univariate logistic regression and four multivariable logistic models adjusting for gland texture, blood loss, neoadjuvant therapy, or pathology.
  • Performed an inverse probability of treatment weighting (IPTW) analysis in a subgroup of 238 patients with complete fistula risk score components.
  • CR-POPF occurred in 8.2% of patients receiving the modified technique versus 15.7% receiving the standard technique (p=0.024; unadjusted OR 0.48, p=0.027).
  • Multivariable models found no significant difference in CR-POPF odds between techniques after adjusting for gland texture (OR 1.27, p=0.646), blood loss (OR 0.66, p=0.341), neoadjuvant therapy (OR 0.65, p=0.215), or pathology (OR 0.54, p=0.07), corroborated by IPTW analysis (OR 3.48, 95% CI 0.90–13.5, p=0.07).
  • Modified technique patients exhibited lower Clavien-Dindo grade ≥ III complications (12% vs. 27%, p=0.002), reoperation rates (6.4% vs. 18.3%, p=0.002), and mean hospital stay (9.5 vs. 13.1 days, p=0.025).

Cite This Study

Papai et al. (2026) studied this question.

synapsesocial.com/papers/6a9d1ea728139818eab219ddhttps://doi.org/10.1007/s00423-026-04231-y
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Intraoperative Mitigation Strategies Aimed at Reducing Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study2026
  2. 2Pancreatico-Jejunostomy Fistula After Pancreaticoduodenectomy: Where Do We Stand? Results from an International Survey2025
  3. 3Pancreatico-Jejunostomy Fistula After Pancreaticoduodenectomy: Where Do We Stand? Results from an International Survey2025
  4. 4A modified perioperative strategy including ultrasonic pancreatic transection and early drain removal after pancreatoduodenectomy: a retrospective before-and-after study2026
  5. 5Dunking Pancreaticojejunostomy With Braun’s Jejunojejunostomy: Perioperative Outcomes of a Hundred Pancreaticoduodenectomies2024