Surgical procedure
PD, pancreatic head and uncinate process
A standard open PD, using a reconstruction in two loops and a PJ, was performed by three surgeons with more than 10 years of experience in pancreatic surgery. Operative technique, patch placement, and drainage were standardized between the three surgeons. PD was performed without pylorus preservation. The pancreatic head and uncinate process were resected beyond the portal vein, and the resection was extended into the retroperitoneal, peripancreatic, pericaval, and interaortocaval lymphatic–fatty tissue with regional lymphadenectomy. For reconstruction, one jejunal limb was moved upwards behind the transverse colon and a PJ was constructed as the first anastomosis, followed by a Roux-en-Y hepatojejunostomy anastomosis. Another jejunal limb was used to perform the gastrojejunostomy in an antecolic position. Finally, a jejunojejunal anastomosis was performed. The PJ was performed in one layer using a continuous barbed suture (V-Loc™ 3/0; Medtronic, Dublin, Ireland) in the posterior and anterior sides of the anastomosis or using a two-layer, duct-to-mucosa, end-to-side technique, with interrupted sutures using monofilament sutures, according to the individual surgeon’s preference. A 5- or 8-Fr internal stent was always placed in the PJ, depending on the diameter of the main pancreatic duct.Different risk factors associated with the onset of POPF