title: A novel triple secured technique for pancreatic reconstruction following pancreaticoduodenectomy for a soft pancreas.
abstract: OBJECTIVE
  Soft pancreases are susceptible to developing pancreatic fistula following pancreaticoduodenectomy. To reduce the incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas, we developed a triple secured technique. In this study, we describe the details of this technique and also report on the postoperative outcomes.
  
  
  METHODS
  The triple secured technique employed an ultrasonic dissector for pancreatic transection with skeletonizing and ligating of the small pancreatic branch ducts, duct-invagination or duct-to-mucosa anastomosis for main pancreatic duct management, and, finally, four large stitches between the pancreatic stump parenchyma and the jejunal seromuscular layer to prevent minor pancreatic leakage. A total of 28 consecutive patients with a soft pancreas who underwent pancreaticoduodenectomy using our technique were included in this study.
  
  
  RESULTS
  Postopetrative complications occurred in 16 patients. Grade B pancreatic fistula developed in 6 patients. However, no grade C pancreatic fistula occurred in this series. Neither any reoperation nor in-hospital mortality was observed in this series.
  
  
  CONCLUSIONS
  Our triple secured technique after pancreaticoduodenectomy was feasible and safe, with an acceptable rate of grade B pancreatic fistula and no grade C pancreatic fistula for patients with a soft pancreas.
authors.forename: K
authors.initials: K
authors.lastname: Kakinoki
authors.forename: K
authors.initials: K
authors.lastname: Okano
authors.forename: M
authors.initials: M
authors.lastname: Oshima
authors.forename: H
authors.initials: H
authors.lastname: Suto
authors.forename: H
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Akamoto
authors.forename: M
authors.initials: M
authors.lastname: Fujiwara
authors.forename: S
authors.initials: S
authors.lastname: Yachida
authors.forename: T
authors.initials: T
authors.lastname: Takama
authors.forename: M
authors.initials: M
authors.lastname: Hagiike
authors.forename: H
authors.initials: H
authors.lastname: Usuki
authors.forename: H
authors.initials: H
authors.lastname: Kamata
authors.forename: T
authors.initials: T
authors.lastname: Masaki
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome