Radiologically-confirmed dehiscence of the pancreaticojejunal anastomosis following pancreaticoduodenectomy: risk factors and implications for technique

Background: Dehiscence of pancreaticojejunal anastomosis is a direct indicator of severe postoperative pancreatic fistula (POPF). This study aimed to analyze the characteristics of anastomotic dehiscence and identify its associated risk factors, with the goal of informing improved treatment strategies. Methods: We conducted a retrospective analysis of 220 patients who underwent pancreaticoduodenectomy (PD) between 2020 and 2024. The clinical features of patients with dehisced anastomosis were summarized. Risk factors for clinically relevant POPF (CR-POPF) and anastomotic dehiscence were evaluated. A subgroup analysis was performed to assess the impact of continuous versus interrupted suturing on anastomotic dehiscence across different patient populations. Results: The incidences of CR-POPF and anastomotic dehiscence were 31.4% and 10.0%, respectively. Anastomotic dehiscence was typically diagnosed at a median of 7 days after PD. Among these patients, post-pancreatectomy hemorrhage (PPH) occurred in 27.3%, and the 90-day mortality rate was 18.2%. Continuous suturing was identified as an independent risk factor for anastomotic dehiscence in both the entire cohort and the CR-POPF subgroup. Subgroup analysis showed that interrupted suturing was associated with a reduced incidence of anastomotic leakage in male patients, those with body mass index (BMI) ≥23 kg/m2, non-pancreatic adenocarcinoma (PDAC) diagnoses, main pancreatic duct diameter 30%. Two representative cases respectively illustrated the successful and unsuccessful treatment processes after the pancreaticojejunostomy rupture occurred. Conclusions: Continuous suturing may be associated with dehiscence of pancreaticojejunal anastomosis in high-risk patients, suggesting that the choice of technique should be individualized. For cases involving high risks, meticulously interrupted suturing may be more effective in preventing anastomotic dehiscence.