title: Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy.
abstract: OBJECTIVE
  To investigate the simplicity, reliability, and safety of the application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy.
  
  
  METHODS
  A retrospective analysis was performed on the data of patients who received pancreaticoduodenectomy completed by the same surgical group between January 2011 and April 2014 in the General Hospital of the People's Liberation Army. In total, 51 cases received single-layer mucosa-to-mucosa pancreaticojejunal anastomosis and 51 cases received double-layer pancreaticojejunal anastomosis. The diagnoses of pancreatic fistula and clinically relevant pancreatic fistula after pancreaticoduodenectomy were judged strictly by the International Study Group on pancreatic fistula definition. The preoperative and intraoperative data of these two groups were compared. χ(2) test and Fisher's exact test were used to analyze the incidences of pancreatic fistula, peritoneal catheterization, abdominal infection and overall complications between the single-layer anastomosis group and double-layer anastomosis group. Rank sum test were used to analyze the difference in operation time, pancreaticojejunal anastomosis time, postoperative hospitalization time, total hospitalization time and hospitalization expenses between the single-layer anastomosis group and double-layer anastomosis group.
  
  
  RESULTS
  Patients with grade A pancreatic fistula accounted for 15.69% (8/51) vs 15.69% (8/51) (P = 1.0000), and patients with grades B and C pancreatic fistula accounted for 9.80% (5/51) vs 52.94% (27/51) (P = 0.0000) in the single-layer and double-layer anastomosis groups. Although there was no significant difference in the percentage of patients with grade A pancreatic fistula, there was a significant difference in the percentage of patients with grades B and C pancreatic fistula between the two groups. The operation time (220.059 ± 60.602 min vs 379.412 ± 90.761 min, P = 0.000), pancreaticojejunal anastomosis time (17.922 ± 5.145 min vs 31.333 ± 7.776 min, P = 0.000), postoperative hospitalization time (18.588 ± 5.285 d vs 26.373 ± 15.815 d, P = 0.003), total hospitalization time (25.627 ± 6.551 d vs 33.706 ± 15.899 d, P = 0.002), hospitalization expenses (116787.667 ± 31900.927 yuan vs 162788.608 ± 129732.500 yuan, P = 0.001), as well as the incidences of pancreatic fistula [13/51 (25.49%) vs 35/51 (68.63%), P = 0.0000], peritoneal catheterization [0/51 (0%) vs 6/51 (11.76%), P = 0.0354], abdominal infection [1/51 (1.96%) vs 11/51 (21.57%), P = 0.0021], and overall complications [21/51 (41.18%) vs 37/51 (72.55%), P = 0.0014] in the single-layer anastomosis group were all lower than those in the double-layer anastomosis group.
  
  
  CONCLUSIONS
  Single-layer mucosa-to-mucosa pancreaticojejunal anastomosis appears to be a simple, reliable, and safe method. Use of this method could reduce the postoperative incidence of complications.
authors.affiliation: Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang, Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Bing-Yang
authors.initials: BY
authors.lastname: Hu
authors.affiliation: Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang, Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Leng
authors.affiliation: Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang, Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wan
authors.affiliation: Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang, Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Wen-Zhi
authors.initials: WZ
authors.lastname: Zhang
keywords: Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticojejunal anastomosis