Pancreatic transection using ultrasonic dissector in pancreatoduodenectomy.
BACKGROUND
Pancreatoenterostomic leakage after pancreatoduodenectomy may be caused partly by pancreatic juice leakage from transected branch pancreatic ducts on the pancreatic cut surface that do not drain into the main pancreatic duct after pancreatectomy.


METHODS
We devised a new technique of pancreatic transection using an ultrasonic dissector followed by duct-to-mucosa pancreatojejunostomy, in order to prevent pancreatoenterostomic leakage after pancreatoduodenectomy in patients with a soft pancreas and a small main pancreatic duct. During pancreatic transection, branch pancreatic ducts and blood vessels are adequately skeletonized and securely ligated. The pancreatic duct is anastomosed to the full thickness of the jejunum with four to six interrupted sutures.


RESULTS
Ten patients with a nondilated pancreatic duct (2 to 3 mm) underwent pancreatoduodenectomy by the present method. During pancreatic transection, 24 to 35 ducts including the pancreatic ducts and blood vessels were skeletonized and ligated. Postoperatively, no patients developed pancreatojejunostomic leakage. The present method may prevent pancreatoenterostomic leakage after pancreatoduodenectomy.
Sugiyama
M
M
First Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Tokyo, Japan. sgym@kyorin-u.ac.jp
Abe
N
N
Izumisato
Y
Y
Tokuhara
M
M
Masaki
T
T
Mori
T
T
Atomi
Y
Y
D000714:Anastomosis, Surgical; D004386:Duodenum / Q000601:surgery; D006801:Humans; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D014464:Ultrasonic Therapy / Q000295:instrumentation*