A simple pancreaticojejunostomy technique for hard pancreases using only two transpancreatic sutures with buttresses: a comparison with the previous pancreaticogastrostomy and dunking methods

Abstract

PurposeIn this study, we introduced a novel technique, the pancreaticojejunostomy (PJ), which uses only two transpancreatic sutures with buttresses (PJt), and compared the surgical outcomes with previously used methods, especially for hard pancreases.MethodsA total of 101 patients who underwent pancreaticoduodenectomy with hard pancreases were enrolled and divided into 3 groups according to the method of pancreaticoenteric anastomosis: 30 patients (29.7%) underwent the conventional dunking method (Du), 31 patients (30.7%) underwent pancreaticogastrostomy using transpancreatic sutures (PGt) and 40 patients (39.6%) underwent PJ using transpancreatic sutures (PJt). The surgical outcomes were compared according to the type of anastomosis to analyze the feasibility and ease of each technique.ResultsThe overall operative time was shorter in the PJt group (325.1 ± 63.8 minutes) than in the PGt group (367.3 ± 70.5 minutes) or the Du group (412.0 ± 38.2 minutes, P < 0.001). In terms of pancreaticoenteric anastomosis time, it was also shorter in the PJt group (10.3 ± 3.5 minutes) than in the Du group (20.7 ± 0.7 minutes) or the PGt group (16.8 ± 5.4 minutes, P = 0.005). Significant postoperative pancreatic fistula (POPF) developed in 2 cases (6.7%) in the Du group, whereas there were no POPF cases in the PGt or PJt groups (P = 0.086). Overall postoperative morbidities occurred in 31 cases (30.7%), and there were no significant differences among the 3 groups (P = 0.692).ConclusionThe novel PJ technique, which uses only two transpancreatic sutures with buttresses, is a very simple, easy and secure method for hard pancreases and can be performed in a shorter amount of time compared with conventional methods.

Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy

“…The higher incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas may be related to insecure suturing and knotting, which can result in unsatisfactory pancreaticojejunal anastomosis and a higher risk of damage to the pancreatic tissue and fine pancreatic ducts during suturing and knotting of a soft pancreas, resulting in pancreatic leakage. The lower incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a hard pancreas may be related to pancreatic exocrine dysfunction due to prolonged pancreatic duct obstruction and pancreatic fibrosis, secure pancreaticojejunal anastomosis, and obstructed minor ducts at the cut-surface of the hard pancreas, and this could help reduce POPF[ 43 ] and risk of damage to the pancreatic tissue and fine pancreatic ducts during suturing and knotting. Pancreatic texture is the most significant single predictor of POPF, and clinicians should select a pancreaticojejunal anastomosis technique based on the texture of the pancreas to reduce the incidence of POPF[ 44 ].…”

Secure reconstruction after pancreaticoduodenectomy: Review and improved our continuous duct-to-mucosa anastomosis

“…Such good results achieved by Peng et al [16] could not be replicated in any of the European or Asian hospitals using the same technique. [17][18][19] Kim et al [20] then modified Peng's technique, and after placing the stump 3 cm deep into the intestine, they used only two transpancreatic U-sutures securing the upper and lower border of the jejunum. Li et al [21] further published a new technique of pancreaticojejunal end-to-end anastomosis with two to four single interrupted U-sutures (Chen's U-suture), performed with double-armed sutures (Fig.…”

Pancreaticojejunostomy—a review of modern techniques

“…Kim et al modified the Peng technique and after placing the stump 3 cm deep into the intestine they used only two transpancreatic U-sutures securing the upper and lower border of the jejunum, about 2 cm from the edge of the pancreatic stump. The sutures were tied using special square buttresses (TFE Polymer Pledget, Ethicon Inc.) [17]. Similarly, Li et al used 3 overlapping transpancreatic U-sutures to secure the pancreatic stump dunked 3 cm deep into the intestine [18].…”