title: A modified technique of end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) represents the most important cause of morbidity after pancreaticoduodenectomy (PD) and contributes to prolonged hospitalization and increased mortality rates. This study presents a new technique, which involves end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures, and evaluates its safety and reliability.
  
  
  METHODS
  From January 2011 to May 2012, 79 patients with periampullary malignancies underwent PD by using this modified technique, and the morbidity and mortality rates were calculated.
  
  
  RESULTS
  In this study, all cases recovered well from PD. Four transpancreatic interlocking mattress sutures were performed in 79 patients. The median duration of surgery was 3.9 hr (range 3.1-6.8), and the median time to perform pancreaticojejunostomy was 15.3 min (range 9-24). Overall, morbidity occurred in 16 patients (22.3%), and the causes included upper gastrointestinal bleeding (n = 2), biliary fistula (n = 1), pulmonary infection (n = 1), delayed gastric emptying (n = 1), abdominal abscess (n = 1, caused by PF), wound infection (n = 3), arrhythmia or myocardial infarction (n = 3), urinary tract infection (n = 2), and POPF (n = 2, 2.53%). One patient had grade A POPF, one had grade B POPF, and none of them had grade C POPF. No death occurred during surgery.
  
  
  CONCLUSIONS
  The end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures is a simple, rapid, safe, and reliable technique with low POPF rate and low delayed massive hemorrhage rate.
authors: Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors: Min
authors: M
authors: Wang
authors: Feng
authors: F
authors: Zhu
authors: Xin
authors: X
authors: Wang
authors: Rui
authors: R
authors: Tian
authors: Chengjian
authors: C
authors: Shi
authors: Ming
authors: M
authors: Shen
authors: Meng
authors: M
authors: Xu
authors: Juan
authors: J
authors: Han
authors: Niannian
authors: N
authors: Luo
authors: Renyi
authors: R
authors: Qin
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques