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A comparison of two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy.

Kusnierz K, Mrowiec S, Lampe P - Gastroenterol Res Pract (2015)

Bottom Line: Results.There was a significant statistical difference in incidents of pancreatic fistula (P < 0.05) and no statistical difference in other postoperative complications or mortality in comparison group.Anastomosis time was statistically shorter in the ST group.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Medical University of Silesia, 14 Medykow Street, 40-752 Katowice, Poland.

ABSTRACT
Background. The aim of the study was to compare two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy. Methods. For effective prevention of the development of pancreatic leakage, we modified invagination technique that we term the "serous touch." We analysed the diameter of the main pancreatic duct, the texture of the remnant pancreas, the method of the reconstruction, pancreatic external drainage, anastomotic procedure time, histopathological examination, and postoperative complications. Results. Fifty-two patients underwent pancreatoduodenectomy with pancreatojejunostomy using "serous touch" technique (ST group) and 52 classic pancreatojejunostomy (C group). In the ST group one patient (1.9%) was diagnosed as grade B pancreatic fistula, and no patient experienced fistula grade A or C. In the C group 6 patients (11.5%) were diagnosed as fistula grade A, 1 (1.9%) patient as fistula grade B, and 1 (1.9%) patient as fistula grade C. There was a significant statistical difference in incidents of pancreatic fistula (P < 0.05) and no statistical difference in other postoperative complications or mortality in comparison group. Anastomosis time was statistically shorter in the ST group. Conclusions. "Serous touch" technique appeared to be easy, safe, associated with fewer incidences of pancreatic fistulas, and less time consuming in comparison with classical pancreatojejunostomy.

No MeSH data available.


Related in: MedlinePlus

(a) Intestinal cuff into which the cut end of the pancreatic remnant is drawn. Visible suture fixing intussusception of the intestine wall. (b) The pancreaticojejunostomy and the drain from Wirsung's duct.
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fig4: (a) Intestinal cuff into which the cut end of the pancreatic remnant is drawn. Visible suture fixing intussusception of the intestine wall. (b) The pancreaticojejunostomy and the drain from Wirsung's duct.

Mentions: Four surgeons performed the anastomoses; however, one of the authors, Pawel Lampe, supervised all the operations. Our modified technique of end-to-end PJ is shown in Figures 1–3. The pancreas is transected with an electrocautery on the scheduled line. Afterwards a hemostasis is performed. The main pancreatic duct is identified. The cut end of the pancreatic remnant is mobilized for approximately 2.5–3 cm to allow its intussuscepting into the intestine. We start with the intestine preparation for the anastomosis. We insert the first out of the three sutures, which will create the intestinal cuff into which the pancreas is intususcepted (3-0 synthetic absorbable monofilament suture) (Figures 2 and 3). These three sutures are put 5-6 cm from the edge of the intestine, so that the cuff is 2.5–3 cm (Figures 2 and 3). After putting three sutures and tying the knots we get the intestine intussusception, cuff (Figures 3 and 4). If we assume that the mesentery connects to the intestine at the 6 o'clock position, we put the sutures at 8 o'clock, 12 o'clock (the antimesenteric side), and 4 o'clock positions. Depending on the diameter of Wirsung's duct and the texture of the pancreas we insert a drain into Wirsung's duct and fix it with 5-0 absorbable sutures to the duct (Figures 3 and 4). The drain is used for external drainage of the pancreatic duct. The drain is fixed to the jejunal wall with Witzel's method using 4-0 synthetic absorbable monofilament suture. The jejunal limb is moved to the pancreatic cut end by a retromesenteric route. Then we begin the pancreatic anastomosis with the intestine with two sutures put on the intestine at around 3 o'clock and 9 o'clock positions (synthetic long-term absorbable monofilament suture, UPS metric size 0 or 1). We put on a suture 4–4.5 cm from the cuff's edge from the outer surface to the inner surface throughout the entire thickness of the bowel, and then the same suture is put on through the thickness of the pancreatic remnant (one suture at both sides of Wirsung's duct) (Figure 3). Next we return again through the full thickness of the bowel. We put on 2 sutures of the type by means of which we draw the pancreas into the formed cuff (Figure 3). After the intussusception of the pancreas into the cuff, the sutures are tied (Figure 4). Next we put on a few additional single sutures (6-8 sutures) connecting the pancreas and the seromuscular layer of the jejunum (4-0 synthetic absorbable monofilament suture).


A comparison of two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy.

Kusnierz K, Mrowiec S, Lampe P - Gastroenterol Res Pract (2015)

(a) Intestinal cuff into which the cut end of the pancreatic remnant is drawn. Visible suture fixing intussusception of the intestine wall. (b) The pancreaticojejunostomy and the drain from Wirsung's duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4380088&req=5

fig4: (a) Intestinal cuff into which the cut end of the pancreatic remnant is drawn. Visible suture fixing intussusception of the intestine wall. (b) The pancreaticojejunostomy and the drain from Wirsung's duct.
Mentions: Four surgeons performed the anastomoses; however, one of the authors, Pawel Lampe, supervised all the operations. Our modified technique of end-to-end PJ is shown in Figures 1–3. The pancreas is transected with an electrocautery on the scheduled line. Afterwards a hemostasis is performed. The main pancreatic duct is identified. The cut end of the pancreatic remnant is mobilized for approximately 2.5–3 cm to allow its intussuscepting into the intestine. We start with the intestine preparation for the anastomosis. We insert the first out of the three sutures, which will create the intestinal cuff into which the pancreas is intususcepted (3-0 synthetic absorbable monofilament suture) (Figures 2 and 3). These three sutures are put 5-6 cm from the edge of the intestine, so that the cuff is 2.5–3 cm (Figures 2 and 3). After putting three sutures and tying the knots we get the intestine intussusception, cuff (Figures 3 and 4). If we assume that the mesentery connects to the intestine at the 6 o'clock position, we put the sutures at 8 o'clock, 12 o'clock (the antimesenteric side), and 4 o'clock positions. Depending on the diameter of Wirsung's duct and the texture of the pancreas we insert a drain into Wirsung's duct and fix it with 5-0 absorbable sutures to the duct (Figures 3 and 4). The drain is used for external drainage of the pancreatic duct. The drain is fixed to the jejunal wall with Witzel's method using 4-0 synthetic absorbable monofilament suture. The jejunal limb is moved to the pancreatic cut end by a retromesenteric route. Then we begin the pancreatic anastomosis with the intestine with two sutures put on the intestine at around 3 o'clock and 9 o'clock positions (synthetic long-term absorbable monofilament suture, UPS metric size 0 or 1). We put on a suture 4–4.5 cm from the cuff's edge from the outer surface to the inner surface throughout the entire thickness of the bowel, and then the same suture is put on through the thickness of the pancreatic remnant (one suture at both sides of Wirsung's duct) (Figure 3). Next we return again through the full thickness of the bowel. We put on 2 sutures of the type by means of which we draw the pancreas into the formed cuff (Figure 3). After the intussusception of the pancreas into the cuff, the sutures are tied (Figure 4). Next we put on a few additional single sutures (6-8 sutures) connecting the pancreas and the seromuscular layer of the jejunum (4-0 synthetic absorbable monofilament suture).

Bottom Line: Results.There was a significant statistical difference in incidents of pancreatic fistula (P < 0.05) and no statistical difference in other postoperative complications or mortality in comparison group.Anastomosis time was statistically shorter in the ST group.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Medical University of Silesia, 14 Medykow Street, 40-752 Katowice, Poland.

ABSTRACT
Background. The aim of the study was to compare two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy. Methods. For effective prevention of the development of pancreatic leakage, we modified invagination technique that we term the "serous touch." We analysed the diameter of the main pancreatic duct, the texture of the remnant pancreas, the method of the reconstruction, pancreatic external drainage, anastomotic procedure time, histopathological examination, and postoperative complications. Results. Fifty-two patients underwent pancreatoduodenectomy with pancreatojejunostomy using "serous touch" technique (ST group) and 52 classic pancreatojejunostomy (C group). In the ST group one patient (1.9%) was diagnosed as grade B pancreatic fistula, and no patient experienced fistula grade A or C. In the C group 6 patients (11.5%) were diagnosed as fistula grade A, 1 (1.9%) patient as fistula grade B, and 1 (1.9%) patient as fistula grade C. There was a significant statistical difference in incidents of pancreatic fistula (P < 0.05) and no statistical difference in other postoperative complications or mortality in comparison group. Anastomosis time was statistically shorter in the ST group. Conclusions. "Serous touch" technique appeared to be easy, safe, associated with fewer incidences of pancreatic fistulas, and less time consuming in comparison with classical pancreatojejunostomy.

No MeSH data available.


Related in: MedlinePlus