title: Combined invagination and duct-to-mucosa techniques with modifications: a new method of pancreaticojejunal anastomosis.
abstract: BACKGROUND
  Soft pancreatic texture and a small main pancreatic duct are thought to be the most significant risk factors for the occurrence of pancreatic fistula (PF), a common and serious complication after pancreaticoduodenectomy (PD). This is in part due to the technical difficulties of pancreaticojejunostomy (PJ) posed by a soft gland with a normal-sized duct. To deal with this problem, we developed a new anastomotic technique which combines the two most widely used techniques, namely, the invagination technique and the duct-to-mucosa technique, with a modification of the suture route and insertion of a temporary stent tube.
  
  
  METHODS
  Between January 2003 and December 2009, ninety-two consecutive patients underwent PD in which the new PJ technique was used. Charts and follow-up data of these patients were reviewed for operative details, early postoperative events, and outcomes at 6 months after the operation. PF was defined by the International Study Group on Pancreatic Fistula (ISGPF) guidelines and graded (A, B or C) according to the clinical procedures and outcome.
  
  
  RESULTS
  In this group of 92 patients, there was only 1 early death from acute renal failure. PF was observed in 11 patients (12.0%), 8 in grade A, 1 in grade B, and 2 in grade C. For the 2 patients in grade C, PF was surgically managed. There were no early or late deaths attributable to PF. Six months after the operation, all of the patients were free of PJ-related symptoms except for 2, who were found to have steatorrhea.
  
  
  CONCLUSIONS
  Our modified technique is simple and safe in PD. Present data suggest that this technique produces excellent early and medium-term results.
authors.affiliation: Second Department of Biliary Surgery and Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.forename: Li
authors.initials: L
authors.lastname: Geng
authors.forename: You-Gang
authors.initials: YG
authors.lastname: Ma
authors.forename: Yong-Jie
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D002681:China; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D045602:Steatorrhea / Q000209:etiology; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult