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

• Published in: Langenbeck's archives of surgery 2009-07, Vol.394 (4), p.739-744
• Main Authors: Chen, Xiao-Ping, Qiu, Fa-Zu, Zhang, Zhi-Wei, Chen, Yi-Fa, Huang, Zhi-Yong, Zhang, Wan-Guang
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - surgery; Adult; Aged; Cardiac Surgery; Common Bile Duct Neoplasms - surgery; Duodenal Neoplasms - surgery; Female; General Surgery; How To Do It; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Pancreatic Fistula - prevention & control; Pancreatic Neoplasms - surgery; Pancreaticojejunostomy - methods; Postoperative Complications - prevention & control; Suture Techniques; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-009-0487-7

Background Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreato-enteric anastomosis after PD have been proposed to reduce POPF rate. Until now, there is no consensus on which is the best. This study presents a new technique of the end-to-end invaginated pancreaticojejunostomy with two to three transpancreatic U-sutures and evaluates its safety and reliability. Material and methods From 2002 to 2007, 88 patients (54 men and 34 women) underwent an invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures after PD. The mean age was 52.4 years (range, 26–74 years). The diseases of the all patients were malignant. Results In all patients of this study, two transpancreatic U-sutures were performed in 59 and three U-sutures in 29. The median duration of surgery was 3.8 h (range 3–6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range 8–25). The median blood loss was 750 ml (range 300–1,800), 36 patients needed transfusion and the median blood transfusion was 380 mL (range 200–1,200). Overall morbidity occurred in 15 patients (17.0%). Only two patients (2.2%) had grade A of POPF and no patient had grade B and grade C of POPF. No operative death occurred. Conclusions An invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures is simple, rapid, safe, and reliable technique, even in some patients with soft pancreas and small pancreatic duct.