Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches

Abstract

AIM:The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e., the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage. METHODS:During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon. RESULTS:There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients (11%) among the interrupted suture cases and in 10 (6%) among the continuous suture cases (P = 0.102). Major pancreatic leakage developed in three interrupted suture patients (2%) and zero continuous suture patients (P = 0.026). In multivariate analysis, soft pancreatic consistency (odds ratio, 5.5; 95% confidence interval 2.3-13.1) and common bile duct cancer (odds ratio, 3.7; 95% CI 1.6-8.5) were predictive of pancreatic leakage. CONCLUSION:Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy.

A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

“…When compared with other studies [27][28][29][30][31][32][33], we found that the results of present study were much better and very encouraging. Except of the above-mentioned, the advantages of our technique are: (1) simple, only two to three transpancreatic U-sutures are placed; (2) easy, no need of isolation of long segment of remnant pancreas as described by Peng et al [25], pancreatic stump could be easily invaginated into the jejunum loop through straining the Usutures; (3) rapid, the median time to perform pancreaticojejunostomy using this technique was only 13.3 min (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

“…The median duration of surgery of 88 patients was 3.8 h (range 3-6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The median blood loss was 750 ml (range 300-1,800), 36 of 88 patients needed transfusion and the median blood transfusion for 56 patients was 380 mL (range 200-1,200).…”

“…In the last two decades, mortality from PD has significantly been reduced by improvement in surgical technique and pre-and postoperative care. The operative mortality rates reported for many high-volume pancreatic surgical centers are less than 4% [11,12,[16][17][18]. However, the postoperative morbidity rate is still 30% to 60% [3,6,9].…”

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

“…Comparing both types of anastomosis, duct-to-mucosa and invagination, the duct-to-mucosa anastomosis was initially described as safer and with a significantly lower rate of fistula [20,21] . Subsequently, in 2003 a prospective randomized trial [8] found PF in 14% of patients: 13% in the group with duct-to-mucosa anastomosis and 15% in the group with anastomosis by invagination, although the difference was not significant.…”

The Best Choice to Achieve Zero Complications after Pancreatoduodenectomy

“…Continuous duct-to-mucosa anastomosis was described as being safer and as having a significantly lower leakage rate [16,17]. However, a prospective randomized clinical trial found it to be favored in low-risk patients with a dilated pancreas duct or firm fibrotic pancreas, whereas the invagination technique was better for highrisk patients with small ducts or a soft friable pancreas [18].…”