title: Chen's U-suture technique for end-to-end invaginated pancreaticojejunostomy following pancreaticoduodenectomy.
abstract: OBJECTIVE
  Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging. This study aims to review a new surgical approach, the Chen's U-stitch technique, for end-to-end invaginated pancreaticojejunostomy, which involves two to four transpancreatic transverse U-sutures, and to evaluate the effectiveness of this approach with reducing the incidence of POPF formation.
  
  
  METHODS
  To evaluate this new approach, during 2002-2012, a total of 264 patients who received the new Chen's U-stitch technique after a PD were included in this study. Postoperative morbidity and mortality, including the incidence of POPF, were analyzed.
  
  
  RESULTS
  Postoperative morbidity was 22.3 % (59/264) and mortality was 0 % (0/264). The POPF rate was 3.4 % (9/264) for Grade A, 0.8 % (2/264) for Grade B, and 0 % (0/264) for Grade C.
  
  
  CONCLUSIONS
  This new surgical technique (Chen's U-stitch), which involves an end-to-end invaginated pancreaticojejunostomy with two to four transpancreatic transverse U-sutures, provides excellent outcomes at reducing the incidence of POPF after PD.
authors: Department of Surgery, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, chenxp@medmail.com.cn.
authors: Xiao-Ping
authors: XP
authors: Chen
authors: Zhi-Yong
authors: ZY
authors: Huang
authors: Josef W Y
authors: JW
authors: Lau
authors: Bi-Xiang
authors: BX
authors: Zhang
authors: Zhi-Wei
authors: ZW
authors: Zhang
authors: Yi-Fa
authors: YF
authors: Chen
authors: Wan-Guang
authors: WG
authors: Zhang
authors: Peng
authors: P
authors: Zhu
authors: Binhao
authors: B
authors: Zhang
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D013536:Suture Techniques; D055815:Young Adult