title: An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture.
abstract: OBJECTIVE
  To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture.
  
  
  METHODS
  Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis.
  
  
  RESULTS
  The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen.
  
  
  CONCLUSIONS
  A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.
authors.affiliation: Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan. hakamada@cc.hirosaki-u.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hakamada
authors.forename: Shunji
authors.initials: S
authors.lastname: Narumi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Toyoki
authors.forename: Masaki
authors.initials: M
authors.lastname: Nara
authors.forename: Kenosuke
authors.initials: K
authors.lastname: Ishido
authors.forename: Takuya
authors.initials: T
authors.lastname: Miura
authors.forename: Norihito
authors.initials: N
authors.lastname: Kubo
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D013537:Sutures
chemical_list: D011098:Polyglactin 910