Pancreaticojejunal anastomosis, using a stent tube, in pancreaticoduodenectomy.
We report our technique for pancreaticojejunostomy, using a stent tube, and examine the literature with regard to the use of a stent tube in pancreaticojejunostomy. The total number of stitches in the anastomosis of the pancreatic parenchyma and seromuscle layer of the jejunum should be more than 20, and there should be more than 8 stitches in the anastomosis of the pancreatic duct and parenchyma and all layers of the jejunal wall, even in a normal-sized main pancreatic duct. There is no dead space between the cut end of the pancreatic parenchyma and the jejunal wall. None of the 114 consecutive patients who underwent pancreaticoduodenectomy in our series died. We use a stent because this makes it easier to perform anterior wall anastomosis of the pancreaticojejunostomy. It is easy to find the pancreaticojejunal anastomosis at the anterior wall anastomosis. We never stitch the posterior wall of the anastomosis with a stent tube in place at the anterior wall anastomosis. If the anastomosis leaks, the massive flow of pancreatic juice around the anastomosis is prevented because of the pancreatic juice flowing out of the pancreatic tube.
Department of Gastroenterological and General Surgery (First Department of Surgery), Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan. wkimura@med.id.yamagata-u.ac.jp
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Kimura
D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome