Metabolic consequences of the occlusion of the main pancreatic duct with acrylic glue after pancreaticoduodenectomy

• Complications related to pancreaticojejunostomy after pancreaticoduodenectomy are still the leading cause of morbidity and mortality of this procedure.
• A solution proposed by some surgeons is the obliteration of main pancreatic duct by acrylic glue, avoiding pancreaticojejunostomy.
• Pancreatic duct occlusion determines a significantly greater impairment in insulin secretion compared with classic pancreaticojejunostomy.

BackgroundPancreaticoduodenectomy represents the major treatment for pancreatic and periampullary neoplasms. Complications related to pancreaticojejunostomy are still the leading cause of morbidity and mortality. A solution proposed by some surgeons is the occlusion of main pancreatic duct by acrylic glue, avoiding pancreaticojejunostomy. Nevertheless, the consequences of this procedure on glucose metabolism are not well-defined.MethodsWe retrospectively analyzed a cohort of 50 patients who underwent pancreaticoduodenectomy and had metabolic assessments available. The metabolic evaluation included the following: body composition and clinical evaluation, an oral glucose tolerance test, and an hyperinsulinemic euglycemic clamp procedure.ResultsTwenty-three patients underwent pancreatic duct occlusion and were compared with 27 patients, well-matched controls, who underwent pancreaticojejunostomy. Pancreatic duct occlusion leads to a greater impairment in insulin secretion compared with classic pancreaticojeunostomy.ConclusionPancreatic duct occlusion is associated with a greater reduction in insulin secretion but does not lead to meaningful differences in the management of patients with diabetes.