title: Continuous versus interrupted suture techniques of pancreaticojejunostomy after pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) has traditionally been a source of significant morbidity and potential mortality after pancreaticoduodenectomy (PD). Both patient-derived and technical factors contribute to pancreatic anastomotic failure. The continuous suture duct-to-mucosa pancreaticojejunostomy (PJ) described previously is associated with a low rate of POPF. The aim of the present study was to observe whether the new technique would effectively reduce the POPF rate in comparison with conventional interrupted suture duct-to-mucosa PJ.
  
  
  METHODS
  Data on 255 consecutive patients, who underwent the two methods of PJ after standard PD by one group of surgeons between 2006 and 2013, were collected retrospectively from a prospective database. The primary end point was the POPF rate. The risk factors of POPF were investigated by using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 120 patients received continuous suture PJ and 135 underwent interrupted suture PJ. Rate of POPF for the entire cohort was 12.5%. There were 9 fistulas (7.5%) in the continuous anastomosis group and 23 fistulas (17%) in the interrupted anastomosis group (P = 0.022). The rates of major complications (Clavien grades 3-5) were less in the continuous anastomosis group (5%) compared with the interrupted anastomosis group (13.3%) (P = 0.023). The greatest risk factor for a POPF was pancreatic duct diameter: POPF developed in only 3 patients (3.6%) with large pancreatic ducts (≥ 3 mm) and in 29 patients (16.9%) with small pancreatic ducts (<3 mm). There were four postoperative (in-hospital) deaths (both in the interrupted anastomosis group); two of which had POPF as the proximate cause of death, followed by bleeding and sepsis.
  
  
  CONCLUSIONS
  The continuous suture duct-to-mucosa PJ effectively reduces the POPF rate after PD in comparison with interrupted anastomosis. The results confirm increased POPF rates in patients with pancreatic duct diameter <3 mm compared with pancreatic duct diameter ≥ 3 mm.
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Nengwen
authors.initials: N
authors.lastname: Ke
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Chunlu
authors.initials: C
authors.lastname: Tan
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Mai
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China. Electronic address: xbliu@medmail.com.cn.
authors.forename: Xubao
authors.initials: X
authors.lastname: Liu
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques
keywords: Continuous running suture; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative pancreatic fistula