A modified technique of end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures
1Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Background:
Postoperative pancreatic fistula (POPF) represents the most important cause of morbidity after pancreaticoduodenectomy (PD) and contributes to prolonged hospitalization and increased mortality rates. This study presents a new technique, which involves end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures, and evaluates its safety and reliability.
Methods:
From January 2011 to May 2012, 79 patients with periampullary malignancies underwent PD by using this modified technique, and the morbidity and mortality rates were calculated.
Results:
In this study, all cases recovered well from PD. Four transpancreatic interlocking mattress sutures were performed in 79 patients. The median duration of surgery was 3.9 hr (range 3.1-6.8), and the median time to perform pancreaticojejunostomy was 15.3 min (range 9-24). Overall, morbidity occurred in 16 patients (22.3%), and the causes included upper gastrointestinal bleeding (n = 2), biliary fistula (n = 1), pulmonary infection (n = 1), delayed gastric emptying (n = 1), abdominal abscess (n = 1, caused by PF), wound infection (n = 3), arrhythmia or myocardial infarction (n = 3), urinary tract infection (n = 2), and POPF (n = 2, 2.53%). One patient had grade A POPF, one had grade B POPF, and none of them had grade C POPF. No death occurred during surgery.
Conclusion:
The end-to-end pancreaticojejunostomy with transpancreatic interlocking mattress sutures is a simple, rapid, safe, and reliable technique with low POPF rate and low delayed massive hemorrhage rate.
