New invagination procedure for pancreaticojejunostomy using only four sutures.
BACKGROUND
Pancreaticoenterostomy remains one of the most stressful parts of pancreatoduodenectomy. We introduce herein a new convenient and secure invagination procedure for pancreaticojejunostomy.


METHODS
We performed our new procedure during pancreatoduodenectomy in 15 consecutive patients (7 men, 8 women). The features of the procedure are as follows. First, it is performed using only four sutures. Second, the pancreas stump is invaginated into the jejunum, mainly by two sutures that penetrate the parenchyma and are continuously purse-string sutured to the jejunum. Third, all needle holes on the surface of the pancreas are covered with the jejunal wall.


RESULTS
Eight patients were classified as showing no pancreatic fistula, and seven displayed a grade A fistula, according to the International Study Group on Pancreatic Fistula criteria. The median operating time for these 15 patients using the present procedure was about 60 min shorter than that for the previous nine patients who underwent duct-to-mucosa pancreaticogastrostomy in our hospital.


CONCLUSIONS
The present method allows pancreaticojejunostomy to be performed swiftly and conveniently.
Department of Surgery, National Hospital Organization, Hakodate Hospital, 18-16 Kawahara-cho, Hakodate, 041-8512, Japan. y.nakanishi@mac.com
Yoshitsugu
Y
Nakanishi
Masanori
M
Ohara
Misa
M
Noguchi
Hiromitsu
H
Domen
Kazuteru
K
Komuro
Satoshi
S
Hirano
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004066:Digestive System Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques