title: A standardized technique for safe pancreaticojejunostomy: Pair-Watch suturing technique.
abstract: OBJECTIVE
  To prevent pancreatic leakage after pancreaticojejunostomy, we designed a new standardized technique that we term the "Pair-Watch suturing technique".
  
  
  METHODS
  Before anastomosis, we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct. The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side, and a total of 7 stitches were put on the posterior wall, followed by the 5 stitches on the anterior wall. Using this technique, twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct. In all cases the amylase activity of the drain were measured. A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.
  
  
  RESULTS
  From March 2007 to July 2008, 29 consecutive cases underwent pancreaticojejunostomy using this technique. Pathologic examination results showed pancreatic carcinoma (n = 14), intraductal papillary-mucinous neoplasm (n = 10), intraductal papillary-mucinous carcinoma (n = 1), carcinoma of ampulla of Vater (n=1), carcinoma of extrahepatic bile duct (n = 1), metastasis of renal cell carcinoma (n = 1), and duodenal carcinoma (n = 1). Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure. The mean diameter of main pancreatic duct was 3.4 mm (range 2-7 mm). Three patients were recognized as having an amylase level greater than 3 times the serum amylase level, but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment. None of the cases developed complications such as hemorrhage, abdominal abscess, and pulmonary infection. There was no postoperative mortality.
  
  
  CONCLUSIONS
  Our technique is less complicated than other methods and very secure, providing reliable anastomosis for any size of pancreatic duct.
authors.affiliation: Yoshinori Azumi, Shuji Isaji, Hiroyuki Kato, Yuu Nobuoka, Naohisa Kuriyama, Masashi Kishiwada, Takashi Hamada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Masami Tabata, Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Azumi
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Yuu
authors.initials: Y
authors.lastname: Nobuoka
authors.forename: Naohisa
authors.initials: N
authors.lastname: Kuriyama
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.forename: Takashi
authors.initials: T
authors.lastname: Hamada
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata