title: End-to-End Invaginated Pancreaticojejunostomy with Three Overlapping U-Sutures--A Safe and Simple Method of Pancreaticoenteric Anastomosis.
abstract: BACKGROUND
  Postoperative pancreatic fistula associated with mortality and morbidity remains an intractable problem after pancreaticoduodenectomy. To date it still carries a notable incidence of roughly 10% to 30% in large series in spite of numerous pharmacological and technical methods that have been proposed to achieve a leakproof pancreatic remnant.
  
  
  METHODS
  In order to perform a safe anastomosis to pancreatic remnant with less sophisticated sutures and shorter operative duration, a fast and simple technique of end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures was devised in our institution.
  
  
  RESULTS
  Between April 2011 and July 2013, end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures technique was used in 23 consecutive cases that underwent pancreaticoduodenectomy in our institute. The median operative time for pancreaticojejunostomy was 12 min. The incidence of pancreatic fistula was 8.7% (n = 2) and both cases were grade A fistula with no clinical impact or delayed hospital discharge. Neither relaparotomy nor postoperative mortality was observed.
  
  
  CONCLUSIONS
  The technique of using three overlapping U-sutures in an end-to-end invaginated pancreaticojejunostomy represents a simple management of pancreaticoenteric anastomosis with reliability and applicability, and provides an alternative choice for pancreaticojejunostomy to senior pancreatic surgeons as well as those without experience.
authors.affiliation: 1Department of General Surgery, Qilu Hospital, Shandong University, Jinan, P.R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Li-Xi
authors.initials: LX
authors.lastname: Luo
authors.forename: Chun
authors.initials: C
authors.lastname: Zhang
authors.forename: Gang-Pu
authors.initials: GP
authors.lastname: Wang
authors.forename: Ze-Ting
authors.initials: ZT
authors.lastname: Chen
authors.forename: Zhi-Chao
authors.initials: ZC
authors.lastname: Jiang
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Wang
authors.forename: Xu-Ting
authors.initials: XT
authors.lastname: Zhi
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D010179:Pancreas / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000517:prevention & control; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013537:Sutures / Q000009:adverse effects
keywords: pancreatic fistula; pancreaticoduodenectomy; pancreaticojejunostomy