The ‘Assam’ technique: a simple, reproducible and leak proof technique of pancreaticojejunostomy after Whipple’s procedure

Abstract

Background: Pancreatico-enteric anastomoses after Whipple’s pancreaticoduodenectomy (PD) has truly remained Achilles' heel in this technically challenging and complex surgery. Many techniques have been developed over decades to reduce the rate of postoperative pancreatic fistula (POPF), which is still the major cause of morbidity and mortality even in the current era. Methods: A retrospective review of all patients who underwent Whipple’s PD by the same surgical team from August 2019 to February 2022 was performed. Results: A total of 41 patients underwent classical Whipple’s PD with the new technique of PJ during the study period. No patient developed clinically significant PF. Delayed gastric emptying was seen in three patients and surgical site infection occurred in three patients. The rate of overall morbidity was 14.3%. Conclusions: This simple and innovative technique significantly reduces the risk of POPF irrespective of pancreatic texture and duct diameter. It is easily reproducible without adversely affecting the operative time.