title: Continuous suture of the pancreatic stump and Braun enteroenterostomy in pancreaticoduodenectomy.
abstract: OBJECTIVE
  To investigate a new modification of pancreaticoduodenectomy (PD)-a mesh-like running suturing of the pancreatic remnant and Braun's enteroenterostomy.
  
  
  METHODS
  Two hundred and three patients underwent PD from 2009 to 2014 and were classified into two groups: Group A (98 patients), who received PD with a mesh-like running suturing for the pancreatic remnant, and Braun's enteroenterostomy; and Group B (105 patients), who received standard PD. Demographic data, intraoperative findings, postoperative morbidity and perioperative mortality between the two groups were compared by univariate and multivariate analysis.
  
  
  RESULTS
  Demographic characteristics between Group A and Group B were comparable. There were no significant differences between the two groups concerning perioperative mortality, and operative blood loss, as well as the incidence of the postoperative morbidity, including reoperation, bile leakage, intra-abdominal fluid collection or infection, and postoperative bleeding. Clinically relevant postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) were identified more frequently in Group B than in Group A. Technique A (PD with a mesh-like running suturing of the pancreatic remnant and Braun's enteroenterostomy) was independently associated with decreased clinically relevant POPF and DGE, with an odds ratio of 0.266 (95%CI: 0.109-0.654, P = 0.004) for clinically relevant POPF and 0.073 (95%CI: 0.010-0.578, P = 0.013) for clinically relevant DGE.
  
  
  CONCLUSIONS
  An additional mesh-like running suturing of the pancreatic remnant and Braun's enteroenterostomy during PD decreases the incidence of postoperative complications and is beneficial for patients.
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Hong-Bo
authors.initials: HB
authors.lastname: Meng
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Wu
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xu
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Zhen-Shun
authors.initials: ZS
authors.lastname: Song
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Gong
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Mahbuba
authors.initials: M
authors.lastname: Khondaker
authors.affiliation: Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10 People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D004766:Enterostomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Braun’s enteroenterostomy; Delayed gastric emptying; Pancreaticoduodenectomy; Postoperative pancreatic fistula; Running suture