Proposal for a Safe and Functional Pancreaticojejunostomy Technique from a Histopathological Perspective

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Digestive System Surgery

Background:

• Complete external drainage is effective for preventing pancreatic juice leakage but complicates pancreaticojejunostomy (PJ).
• Histopathological findings indicate significant pancreatic juice drainage from ducts other than the main pancreatic duct (MPD).
• Conventional PJ techniques face challenges with MPD ligation during pancreaticoduodenectomy (PD).

Purpose of the Study:

• To evaluate a new conceptual technique for duct-to-mucosa PJ after PD.
• To achieve simultaneous drainage of branch pancreatic ducts and complete external drainage of MPD.
• To prevent pancreatic fistula (PF) formation and maintain pancreatic duct patency.

Main Methods:

• A novel PJ technique was developed, building on conventional "two-row" anastomosis.
• A stent tube is secured to the MPD and surrounding tissue using a purse-string suture at the pancreatic transection site.
• Duct-to-mucosa PJ is performed concurrently with MPD stenting.

Main Results:

• The technique was applied to 12 patients with soft pancreas undergoing PD.
• Of these, 4 patients developed Grade A pancreatic fistula (PF).
• No patients experienced Grade B or C PF, indicating successful prevention of severe fistulas.

Conclusions:

• The proposed anastomotic technique effectively prevents pancreatic fistula.
• The technique ensures the patency of the pancreatic duct post-surgery.
• This method offers a promising solution for managing pancreatic juice drainage after PD.