Is stenting necessary for a successful pancreatic anastomosis?

The effect of stenting on pancreaticojejunostomy has not been studied in a prospective randomized trial. In 34 dogs, the left pancreatic lobe was anastomosed to a Roux-Y jejunal limb using a two-layer mucosa-to-mucosa technique. In one group (n = 12), the anastomosis was constructed over a 3F polytetrafluoroethylene (PTFE) stent, and the stent was left in situ. A second group (n = 12) had the stent removed at the completion of the anastomosis. A control group (n = 10) had the anastomosis constructed without a stent. After 1 month, autopsies were performed, and anastomoses were examined for evidence of leak, occlusion, or stenosis. No anastomotic leaks occurred when a stent was used, whereas one (10%) occurred when no stent was used. No occlusions occurred in the two groups with stents, but two (20%) occurred in the no-stent group. Stenosis rates were 0% in the stent-in group, 25% in the stent-out group, and 30% in the no-stent group. Although no comparisons were statistically significant, there was a trend. Anastomoses performed over a stent, whether or not the stent was left in situ, had lower rates of leak, occlusion, and stenosis. We believe, but cannot prove, that a stent improves anastomotic integrity and patency by facilitating exact placement of mucosal sutures.