title: Pancreaticojejunostomy with double-layer continuous suturing is associated with a lower risk of pancreatic fistula after pancreaticoduodenectomy: a comparative study.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreatoenteric anastomosis after PD have been proposed to reduce POPF rate. In this article we focused on evaluating whether the double layer continuous suture technique was better than the double layer interrupted suture technique in pancreatic-enteric anastomosis after PD.
  
  
  METHODS
  From 2012 to 2013, 114 patients (67 men and 47 women) underwent a pancreatic-enteric anastomosis after PD were analysed. There were 79 patients using the double layer continuous suture technique and 35 patients were using the double layer interrupted suture technique. The operation time, intraoperative blood loss, initial postoperative day of oral feeding, postoperative hospital stay and the presence of main early complications (pancreatic fistulas) were evaluated by chi-square test or unpaired t-test in this study.
  
  
  RESULTS
  Pancreatic fistulas occurred in patients with double layer continuous suture was 17.14%(6/35), and in those with interrupted suture was 39.24%(31/79) (p<0.05). Grade A of POPF was found in 4 patients (4/35, 11.43%) of the double layer continuous suture group and in 5 patients (5/79, 6.33%) of the double layer interrupted suture group. Grade B of POPF was identified only in 1 patients (1/35, 2.83%) of the double layer continuous suture group and in 23 patients (23/79, 29.11%) of the double layer interrupted suture group. The presence of Grade C pancreatic fistulas was only documented in one patient in the double layer continuous suture group and 3 patients in the interrupted suture group. No operative or in-hospital deaths occurred.
  
  
  CONCLUSIONS
  The double-layer continuous suturing after PD is safe, reliable, rapid, favorable and associated with a lower risk of pancreatic fistula than the double layer interrupted suture.
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: jiweiping19841022@126.com.
authors.forename: Weiping
authors.initials: W
authors.lastname: Ji
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: szlaugh@163.com.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Shao
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: zhengkl828@126.com.
authors.forename: Kailian
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: wangjuan861016@126.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: smmusb@126.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: bakouun@163.com.
authors.forename: Hongyun
authors.initials: H
authors.lastname: Ma
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: tlehbh@126.com.
authors.forename: Liang
authors.initials: L
authors.lastname: Tang
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: shiligang1@hotmail.com.
authors.forename: Ligang
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: oceansayhello@126.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: xingxin123456@sina.com.
authors.forename: Xinxing
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: 23822520@qq.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: 18817350420@126.com.
authors.forename: Yijie
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Shanghai Chang Hai Hospital, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China. Electronic address: jingang1971@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Jin
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques / Q000009:adverse effects*
keywords: Double layer continuous suture; Pancreaticoduodenectomy (PD); Postoperative pancreatic fistula