A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures--early postoperative outcomes in consecutive 88 cases.
BACKGROUND
Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreato-enteric anastomosis after PD have been proposed to reduce POPF rate. Until now, there is no consensus on which is the best. This study presents a new technique of the end-to-end invaginated pancreaticojejunostomy with two to three transpancreatic U-sutures and evaluates its safety and reliability.


METHODS
From 2002 to 2007, 88 patients (54 men and 34 women) underwent an invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures after PD. The mean age was 52.4 years (range, 26-74 years). The diseases of the all patients were malignant.


RESULTS
In all patients of this study, two transpancreatic U-sutures were performed in 59 and three U-sutures in 29. The median duration of surgery was 3.8 h (range 3-6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range 8-25). The median blood loss was 750 ml (range 300-1,800), 36 patients needed transfusion and the median blood transfusion was 380 mL (range 200-1,200). Overall morbidity occurred in 15 patients (17.0%). Only two patients (2.2%) had grade A of POPF and no patient had grade B and grade C of POPF. No operative death occurred.


CONCLUSIONS
An invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures is simple, rapid, safe, and reliable technique, even in some patients with soft pancreas and small pancreatic duct.
Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, People's Republic of China. ChenXP@medmail.com.cn
Xiao-Ping
XP
Chen
Fa-Zu
FZ
Qiu
Zhi-Wei
ZW
Zhang
Yi-Fa
YF
Chen
Zhi-Yong
ZY
Huang
Wan-Guang
WG
Zhang
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome