title: Pancreatico-jejunal anastomosis with invaginating jenunal "J"-loop. Preliminary report of a new technique.
abstract: BACKGROUND
  The pancreatic anastomosis is the most demanding step after pancreaticoduodenectomy (PD) and the pancreatic fistula (PF) is the most dreaded complication. Many techniques have been investigated to assess the best way to deal with the pancreatic stump after PD and none of these has shown to be superior in terms of statistically significant reduction of PF rate. We report the preliminary experience of a new technique of pancreaticojejunostomy (PJ).
  
  
  METHODS
  Fifteen patients underwent PD for neoplasms with end-to-side PJ with dunking jejunal "J"-loop, between July 2011 and March 2014. The data about their post-operative outcomes were analyzed.
  
  
  RESULTS
  There were no intra-operative neither post-operative deaths. One patient had a grade A PF (6.7%). Total post-operative complications occurred in 6 patients (40%), major post-operative complications occurred in 3 patients (20%).
  
  
  CONCLUSIONS
  The new "sandwich" technique for dunking PJ after PD that we describe proved to be easy to perform and sure. It appears to be suitable for a dunking PJ when the diameter of the jejunum is too small than this of the pancreatic stump.
authors.affiliation: "San Matteo degli Infermi" Hospital, AUSL Umbria 2, Via Loreto, 06049 Spoleto, Italy; University of Perugia, PhD School in Biotechnologies, Italy. Electronic address: walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy; "San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: General Surgery, "San Giovanni Battista Hopsital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mariani
authors.affiliation: General Surgery, "San Giovanni Battista Hopsital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Longaroni
authors.affiliation: General Surgery, "San Giovanni Battista Hopsital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Federici
authors.affiliation: University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy; General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: General Surgery, "San Giovanni Battista Hopsital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mariani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Anastomosis; Pancreas surgery; Pancreatico-jejunal; Pancreaticojejunostomy; pancreatic resection