title: Minimizing shear and compressive stress during pancreaticojejunostomy: rationale of a new technical modification.
abstract: The failure of the pancreaticojejunal anastomosis remains an important and potentially lethal postoperative complication after pancreaticoduodenectomy. During the pancreaticojejunostomy, creation of compressive and shear forces during suture placement and knot tying may cause deformation of and cutting through the fragile pancreatic parenchyma. We sought to understand the mechanics of needle-pancreas interaction and make adjustments to our pancreaticojejunostomy technique so that the creation of shear and compressive stress could be minimized. We provide a detailed description, a mathematical model, and analysis of the outcomes of our new technical modifications.
authors.affiliation: Department of Surgery, Danbury Hospital Medical Arts Center, Danbury, Connecticut2currently with the Surgical Endocrine Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Vladimir K
authors.initials: VK
authors.lastname: Neychev
authors.forename: Pierre F
authors.initials: PF
authors.lastname: Saldinger
authors.affiliation: Department of Surgery, New York Hospital Queens, Flushing, New York.
authors.forename: Pierre F
authors.initials: PF
authors.lastname: Sladinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology