Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function.
OBJECTIVE
To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods.


METHODS
A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to-mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site.


RESULTS
The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain. Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue.


CONCLUSIONS
A mucosa-to-mucosa pancreatico-jejunostomy is the best choice for anastomotic patency when compared with EEPJ. BPJ can effectively maintain anastomotic patency and preserve pancreatic exocrine function as well as ESPJ.
Bai
Ming-Dong
MD
Department of General Surgery, The Second Affiliated Hospital, Xuzhou Medical College, Xuzhou, Jiangsu Province, China. bmingdong@163.com
Rong
Liang-Qun
LQ
Wang
Lian-Chen
LC
Xu
Hai
H
Fan
Rui-Fang
RF
Wang
Pei
P
Chen
Xiao-Peng
XP
Shi
Liu-Bin
LB
Peng
Shu-You
SY
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001835:Body Weight; D006801:Humans; D046790:Pancreas, Exocrine / Q000033:anatomy & histology / Q000378:metabolism / Q000601:surgery; D010186:Pancreatic Function Tests; D010193:Pancreaticojejunostomy / Q000379:methods*; D011184:Postoperative Period; D011897:Random Allocation; D013552:Swine