title: A new technique for pancreaticogastrointestinal anastomosis without suturing the pancreatic parenchyma.
abstract: BACKGROUND
  In an attempt to lessen the incidence of pancreatic fistula and the disruption of pancreatic anastomosis after pancreatoduodenectomy, we have developed a new technique for pancreaticogastrointestinal anastomosis that consists of pancreatectomy using the ultrasonic dissector and implantation of the pancreatic duct into the gastrointestinal tract without suturing the pancreatic parenchyma. The purpose of this study is to evaluate the safety and reliability of this new technique in a canine model of pancreaticogastrostomy and pancreaticoduodenostomy using 10 beagle dogs.
  
  
  METHODS
  Canine pancreas was resected using the ultrasonic dissector. In the distal pancreas, a 1-cm long stump of the main pancreatic duct was freed and the other smaller pancreatic ducts were skeletonized and securely ligated. The main pancreatic duct was implanted into the stomach or the duodenum and fixed to the seromuscular layer with purse-string sutures without suturing the pancreatic parenchyma.
  
  
  RESULTS
  There was no anastomotic leakage, signs of peritonitis, or abscess formation, and the pancreas was grossly normal in appearance seven days after operation. Histologic examination of the specimens harvested 30 days after operation revealed good connective tissue union between the pancreas and the gastric or duodenal wall, and good mucosal continuity between the pancreatic duct and the stomach or duodenum.
  
  
  CONCLUSIONS
  This new technique is simple, safe, and reliable, and is recommended as an alternative method for restoring pancreaticogastrointestinal continuity after pancreatoduodenectomy.
authors.affiliation: First Department of Surgery, Kobe University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Y
authors.initials: Y
authors.lastname: Tanioka
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Y
authors.initials: Y
authors.lastname: Kim
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: T
authors.initials: T
authors.lastname: Ajiki
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Ku
authors.forename: Y
authors.initials: Y
authors.lastname: Saitoh
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004285:Dogs; D004385:Duodenostomy / Q000379:methods; D004386:Duodenum / Q000473:pathology; D005069:Evaluation Studies as Topic; D005774:Gastrostomy / Q000379:methods; D010179:Pancreas / Q000473:pathology; D010183:Pancreatic Ducts / Q000601:surgery; D010185:Pancreatic Fistula / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012449:Safety; D013270:Stomach / Q000473:pathology; D013536:Suture Techniques; D013997:Time Factors