Inclusion criteria | |
(1) Pancreatic or periampullary lesions requiring pancreatoduodenectomy | |
(2) Planned pancreaticojejunostomy including duct-to-mucosa anastomosis | |
(3) Main pancreatic duct diameter ≤ 3 mm on the left side of the portal vein on preoperative imaging (computed tomography or magnetic resonance imaging) | |
(4) Performance status (Eastern Cooperative Oncology Group scale): 0–1 at the time of enrolment | |
(5) Age 20 years or older | |
(6) Adequate organ function | |
(a) Leukocyte count ≥ 2500 mm3, ≤ 14000 mm3 | |
(b) Haemoglobin ≥ 9.0 g/dl | |
(c) Platelet count ≥ 100,000 mm3 | |
(d) Total bilirubin ≤ 2.0 mg/dl (does not apply to patients with obstructive jaundice) | |
(e) Creatinine ≤ 2.0 mg/dl | |
(7) Ability to understand and willingness to sign written informed consent document | |
Exclusion criteria | |
(1) Planned pancreatogastrostomy | |
(2) Laparoscopic or laparoscope-assisted pancreatoduodenectomy | |
(3) Pancreatic parenchymal atrophy or calcification due to chronic pancreatitis | |
(4) Neoadjuvant treatment including chemotherapy or radiotherapy | |
(5) History of upper abdominal surgery (both of open and laparoscopic) except cholecystectomy | |
(6) Emergency surgery | |
(7) Arterial reconstruction such as superior mesenteric artery, common hepatic artery or celiac artery | |
(8) Severe ischaemic heart disease | |
(9) Severe liver dysfunction due to liver cirrhosis or active hepatitis | |
(10) Severe respiratory disorder requiring oxygen | |
(11) Chronic renal failure with dialysis | |
(12) Requiring resection of other organs (liver or colon) during pancreatoduodenectomy | |
(13) Immunosuppressive treatment | |
(14) History of severe hypersensitivity to polyglycolic acid felt or fibrin glue | |
(15) Other severe drug allergies | |
(16) Contrast media allergy for both iodine and gadolinium | |
(17) Active duplicate cancer thought to affect adverse events | |
(18) Severe psychological or neurological disease | |
(19) Drug or alcohol abuse | |
(20) Planned use of octreotide |