title: The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon's experience.
abstract: OBJECTIVE
  Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call "inverted mattress PJ (IM)". The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF.
  
  
  METHODS
  From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs.
  
  
  RESULTS
  The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P < 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths.
  
  
  CONCLUSIONS
  IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.
authors.affiliation: Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Heon Tak
authors.initials: HT
authors.lastname: Ha
authors.affiliation: Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Young Yeun
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Sang Geol
authors.initials: SG
authors.lastname: Kim
keywords: Pancreatic fistula; Pancreaticojejunostomy