Use of the continuous suture technique in dunking pancreatojejunostomy without stenting.
OBJECTIVE
To evaluate the newly developed continuous suture technique in dunking pancreatojejunostomy without pancreatic duct stenting after pancreatoduodenectomy (PD).


METHODS
Thirty-four consecutive pancreaticojejunostomies (patient age 73 ± 11, 41-88) with continuous sutures without stenting after PD were performed from 2006 to 2011. This study evaluated the operation time, intraoperative blood loss, initial postoperative day of oral feeding, postoperative hospital stay, postoperative early complications, and late complications. The indications for surgery included bile duct cancer (n = 12), pancreatic cancer (n = 11), intraductal papillary mucinous neoplasm (n = 3), cancer of the papilla (n = 3), duodenal cancer (n = 2), and others (n = 3). Portal vein or superior mesenteric vein resections and reconstructions were performed in 7 patients, and another organ was resected in 3.


RESULTS
No operative or in-hospital deaths occurred. The operation time (minutes) was 315 ± 68 and, postoperative hospital stay (days) was 27 ± 16. Pancreatic fistula, wound infection, and delayed gastric emptying were observed in 15, 15, and 9 %, respectively. Grade C pancreatic fistula was seen in 2 patients. Both recovered after laparotomy and drainage and were successfully discharged. Worsening diabetes mellitus was seen in 2 of 34 patients, and dilatation of the pancreatic duct was seen in 3 of 28 patients.


CONCLUSIONS
The newly developed continuous suture technique in dunking pancreatojejunostomy without stenting may therefore produce favorable results in PD.
Department of Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi 756-0095, Japan. tmekatoh@h.do-up.com
Tomoe
T
Katoh
Kazuaki
K
Kawano
Akira
A
Furutani
Takefumi
T
Katsuki
Masahiko
M
Onoda
Atsunori
A
Oga
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010183:Pancreatic Ducts; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome