title: Pancreatico-jejunostomy with a biodegradable pancreatic stent and without stitches through the pancreas.
abstract: Previous experimental studies have shown that multiple puncturing and stitching of the pancreas results in an increased pancreatic injury response. Furthermore, post-operative pancreatitis, which still is a largely under-diagnosed condition, appears to be an important mediator of many post-operative complications after pancreatic head resection. Stenting has been suggested to improve both short-term and long-term outcome after pancreaticojejunostomy. We have recently developed a biodegradable, radiopaque self-expanding stent, which has experimentally been shown suitable for pancreatobiliary applications. In this pilot study we tested the new technique for pancreatico-jejunostomy in 3 patients. In this novel anastomosis technique with a biodegradable stent the pancreatic stump is first sunk into the jejunum and tightened with a purse string in the bowel serosa, without any stitches through the pancreatic tissue, and the patency of the pancreatic duct is secured with a biodegradable stent against the compression of the tightened purse-string. The creation of anastomosis was possible as planned in all 3 patients. They all recovered without complications. The stent was seen in x-ray in all 3 during hospitilization, was found to have disappeared by 1 month in 2 patients, but was still in place at 3 months in 1 patient. The initial experiences described herein encourage progression to a phase I safety study, and later possibly to a phase II randomized trial to test the efficacy of the new method.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. isto.nordback@pshp.fi
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
authors.forename: Teemu
authors.initials: T
authors.lastname: Lämsä
authors.forename: Johanna
authors.initials: J
authors.lastname: Laukkarinen
authors.forename: Jenni
authors.initials: J
authors.lastname: Leppiniemi
authors.forename: Minna
authors.initials: M
authors.lastname: Kellomäki
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010193:Pancreaticojejunostomy; D010865:Pilot Projects; D015607:Stents