Background: As survival following PD improved, long-term complications have emerged as an issue in current era. Pancreaticojejunostomy stenosis is the common long-term sequel after PD but rarely addressed. This study aimed to investigate the benefit of pancreatic duct stent in reducing PJ stenosis after PD. Methods: Between July 2006 and July 2019, patients undergoing PD with follow-up more than 1 year were recruited. Patients were divided into internal stent, external stent, and no stent groups. We reviewed the Computed tomography (CT) to measure the diameter of pancreatic duct and stent migration at 3 months and 1 year after PD. PJ stenosis was defined as pancreatic duct diameter > 3 mm. Perioperative variables were collected for analysis. Results: Totally, 506 patients were included 349 patients in internal stent group, 84 patients in the external stent, and 73 patients in no stent group. There was no difference in preoperative P-duct size between the IS and ES group (3.39 ± 1.78 mm vs 3.26 ± 1.89 mm, p = 0.481), while the P-duct size was larger in ES group compared to the IS group (3.22 ± 2.44 mm vs. 1.94 ± 2.08 mm, p < 0.001) one year after PD. In the internal stent group, the rate of stent migration was 22.1% at 3 months and 67.9% at 1 year post-operatively. CR-POPF (OR 2.24, p = 0.015) and P-duct stent retention at PJ > 3 months (OR 0.45, p < 0.001) were the independent factors for 1-year PJ stenosis in multivariate analysis. Conclusion: Retention of internal pancreatic duct stents at the anastomosis for more than 3 months can reduce post-PD PJ stenosis. Extended retention of internal pancreatic duct stents reduces PJ stenosis, highlighting its critical role in preventing long-term complications.

New-onset diabetes mellitus (NODM) following distal pancreatectomy (DP) significantly impacts long-term quality of life. This study developed a prediction model for post-DP NODM. Retrospective analysis of 159 patients undergoing DP for benign/low-grade malignant lesions (2014-2023). Cox regression identified risk factors incorporated into a scoring system. Among 130 non-diabetic patients, 26.9 ​% developed NODM (median 10 months). Five independent predictors: prediabetes (HR 11.02), concomitant splenectomy (HR 2.45), age ≥65 (HR 2.03), BMI ≥25 (HR 1.96), neck/proximal tumor (HR 1.50). The risk scoring system (0-10 points) stratified patients into low-risk (0-2 points), intermediate-risk (3-5 points), and high-risk (6-10 points) categories with significantly different cumulative incidence of NODM at 5 years (4.4 ​%, 27.9 ​%, and 87.5 ​%, respectively). AUC exceeded 0.85 across timepoints. This simple model enables accurate risk stratification for post-DP NODM, facilitating personalized counseling and tailored surveillance.

Afferent loop syndrome (ALS) after pancreaticoduodenectomy (PD) is typically caused by mechanical obstruction. Reverse-orientation small-bowel anastomosis