Modified Technique of Pancreaticojejunal Anastomosis with Invagination Following Pancreaticoduodenectomy: A Cohort Study

Abstract

We reported our pancreaticojejunostomy anastomosis technique with a pancreatic fistula rate of 0% and low intra-abdominal complication rate. The favorable results of this technique warrant further investigation in large prospective cohort studies and prospective randomized controlled studies.

An easy and secure pancreaticogastrostomy after pancreaticoduodenectomy: transpancreatic suture with a buttress method through an anterior gastrotomy

“…For these reasons, the management of a pancreatic remnant after PD has been of great concern to pancreatic surgeons and numerous techniques to reduce the pancreatic fistula have been described such as PJ or PG, end-to-end or end-to-side anastomosis, invagination or duct-to-mucosa anastomosis, the use of an isolated Roux-en-Y limb, binding PJ, the pancreatic duct stenting methods, application of topical adhesives and duct occlusion without pancreatoenteric anastomosis [1,4-11,19]. We started to adapt PG after PD in 2001 because of the superiority of PG over the PJ: the proximity of the stomach and the pancreas, the thick posterior wall and excellent blood supply of the stomach, a lack of enzyme activation in the stomach and finally less tension on the anastomosis through the nasogastric continuous decompression of the stomach.…”

“…Many reconstruction techniques have been extensively studied in the last two decades in an attempt to reduce the incidence of pancreatic fistula [1-12]. …”

La tranche pancréatique après duodénopancréatectomie céphalique : « un talon d’Achille » très étudié…

“…Des sutures en un, deux ou trois plans successifs [13], à points séparés ou par surjets sont rapportées [14], à points transfixiants le pancréas de part en part [15] ou plus périphériques [12], là encore sans preuve établie de la supériorité d'une technique sur les autres. 3) à été rapportée par des équipes asiatiques avec des taux de FP nuls et une morbidité étonnamment faible, inférieure à 10 % [22]. Le renforcement de l'appui des points par une plaque de Vicryl ® enveloppant l'extrémité du pancréas [17], la section du pancréas au bistouri ultrasonique [18] pour mieux isoler le canal de Wirsung ont été proposés dans des études non comparatives.…”

The Controlled Release of Basic Fibroblast Growth Factor Promotes a Rapid Healing of Pancreaticojejunal Anastomosis with Potent Angiogenesis and Accelerates Apoptosis in Granulation Tissue

“…Modified anastomotic techniques have been proposed for the prevention of PF, but thus far they have only been successful in reducing the fistulas rather than eliminating them altogether [3,4]. A novel approach capable of achieving zero PF is awaited.…”