Median appropriateness scores for surgical techniques for pancreaticoduodenectomy
| Intervention | Scenario | ||||
|---|---|---|---|---|---|
| < 3-mm duct, soft pancreas | ≥ 6-mm duct, soft pancreas | < 3-mm duct, firm pancreas | ≥ 6-mm duct, firm pancreas | Blood loss > 400 mL | |
| Pancreaticogastrostomy | 8 (appropriate) | 7 (appropriate) | 6 | 6 | 6 |
| Pancreaticojejunostomy | 6 | 7 (appropriate) | 6 | 8 (appropriate) | 7 (appropriate) |
| Duct-to-mucosa anastomosis | 7 (appropriate) | 7 (appropriate) | 7 (appropriate) | 7 (appropriate) | 7 (appropriate) |
| Dunking anastomosis | 6 | 6 | 7 (appropriate) | 6 | 6 |
| Adjunct: autologous patch | 5 | 4 | 4 | 4 | 4 |
| Adjunct: sealant, fibrin glue | 4 | 4 | 4 | 4 | 4 |
| Adjunct: sealant, PGA mesh | 5 | 4 | 4 | 4 | 4 |
| Internal stent (for PJ or PG) | 5 | 5 | 5 | 4 | 5 |
| External stent (for PJ) | 5 | 5 | 5 | 4 | 5 |
| No stent (for PJ or PG) | 5 | 6 | 6 | 6 | 6 |
| No drain for PG | 3 (inappropriate) | 4 | 4 | 5 | 5 |
| No drain for PJ | 3 (inappropriate) | 4 | 5 | 6 | 5 |
| Drain for PG | 7 (appropriate) | 5 | 5 | 5 | 5 |
| Drain for PJ | 7 (appropriate) | 7 (appropriate) | 5 | 5 | 5 |
| If drain: suction drainage | 5 | 5 | 5 | 5 | 5 |
| If drain: gravity drainage | 6 | 6 | 5 | 5 | 5 |
PG = pancreaticogastrostomy; PGA = polyglycolic acid; PJ = pancreaticojejunostomy.