Abe H et al. (2005) The selection of pancreatic reconstruction techniques gives rise to higher incidences of morbidity: results of the 30th Japan Pancreatic Surgery Questionnaire Survey on pancreatoduodenectomy in Japan. J Hepatobiliary Pancreat Surg 12: 109–115

The impact on morbidity of the surgical strategy employed by surgeons when carrying out pancreatic reconstruction techniques (PRTs) following pancreatoduodenectomies (PD) was recently assessed via a questionnaire survey in Japan.

Abe and colleagues looked at the relationship between the number of PRTs employed by a particular institution, and the corresponding number of incidences of patient hemorrhages following PD. Surgeons from the Japan Pancreatic Surgery Club completed the researchers' survey, and data analysis was carried out on their responses.

It emerged that 64% of the 152 surgeons used a single PRT when performing PD, with the remaining 36% selecting from two or more PRTs. The volume of patients seen within a particular hospital did not bear relation to the frequency of PRT selection over use of a single PRT. The authors found that, in hospitals where multiple PRTs were employed, the incidence of 'all arterial hemorrhage' and 'delayed arterial hemorrhage' following PD was significantly higher than in those hospitals where only one PRT was in use (P <0.05).

The authors conclude from their study that the better outcome following PD seen in patients who are treated in institutions employing a single PRT rather than multiple PRTs stems from the expert surgical skills in pancreatic reconstruction gained through frequent repetition of the same surgical technique in these hospitals.