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Continuous suturing with two anterior layers reduces post-operative complications and hospitalization time in pancreaticoenterostomy.

Yao G, Fan Y, Zhai J - BMC Gastroenterol (2016)

Bottom Line: Although the total operation times were not reduced, the suturing time for the pancreaticoenterostomies in the continuous suture group (11.3 ± 1.8 min) was greatly reduced compared with that for the interrupted suture group (14.1 ± 2.9 min, p = 0.045).Importantly, the continuous mattress suturing method significantly decreased short-term post-operative complications, including pancreatic leakage (p = 0.042).Continuous mattress suturing is a safe and effective pancreaticoenterostomy method that leads to reduced complications and hospitalization times.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471003, People's Republic of China.

ABSTRACT

Background: Most complications after pancreaticoduodenectomy (PD) were relation to pancreaticoenterostomy. We improved a new method of pancreaticoenterostomy that included the continuous suturing of the jejunum and the stump of the pancreas end-to-side with one layer posteriorly and two layers anteriorly. To evaluate the safety and efficiency of this new method, we introduced this retrospectively compared trial.

Methods: We compared 45 patients who had undergone pancreaticoduodenectomy with either the regular interrupted suturing method or the new continuous mattress suturing method in our hospital from September 2011 to March 2014.

Results: Although the total operation times were not reduced, the suturing time for the pancreaticoenterostomies in the continuous suture group (11.3 ± 1.8 min) was greatly reduced compared with that for the interrupted suture group (14.1 ± 2.9 min, p = 0.045). Importantly, the continuous mattress suturing method significantly decreased short-term post-operative complications, including pancreatic leakage (p = 0.042). Furthermore, shorter hospitalization times were observed in the continuous mattress suture group (12.3 ± 5.0 d) than in the interrupted suture group (24.2 ± 11.6 d, p = 0.000).

Conclusions: Continuous mattress suturing is a safe and effective pancreaticoenterostomy method that leads to reduced complications and hospitalization times.

No MeSH data available.


Related in: MedlinePlus

A knot was tied at the very upper edge of the pancreas and the first layer suture was finished
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Fig4: A knot was tied at the very upper edge of the pancreas and the first layer suture was finished

Mentions: The patients were sufficiently physiologically and psychologically prepared before the operations. During the operations, the transfixations of the upper and lower edges of the stump of the pancreas were emphasized to decrease blood loss before the transection of the pancreas. A pancreatic duct stent was used to the fix the stump of pancreas for at least 15 cm to drain the pancreatic jaundice to the distal end of the jejunum and was placed at least 10 cm away from the anastomosis of the cholangioenterostomy. The stump of the jejunum was pulled to the stump of the pancreas behind the transverse mesocolon without tension. The stump of the pancreas was invaginated into the jejunum by at least 2–3 cm and fixed with 3-0 polypropylene suture (Prolene, Ethicon). The difference between the continuous suturing and interrupted suturing was limited to the procedure of suturing the pancreaticoenterostomy. The interrupted suturing involved one layer of discontinuous sutures with distances of 2–3 mm between each pair of stitches. The continuous suturing involved one layer posteriorly and two layers anteriorly. A 3-0 polypropylene suture was used to complete the suturing from the very upper edge of the pancreas to the lower edge through the posterior edge of the pancreas, and the anterior suture was then completed with the suture. Finally, a knot was tied at the upper edge of the pancreas with the very end of the suture (Figs. 1, 2, 3 and 4). After the first-layer suture, a second-layer suture was applied from at the end edge of the lateral opening of the jejunum anteriorly from the very lower edge of the pancreas to the very upper edge (Fig. 5).Fig. 1


Continuous suturing with two anterior layers reduces post-operative complications and hospitalization time in pancreaticoenterostomy.

Yao G, Fan Y, Zhai J - BMC Gastroenterol (2016)

A knot was tied at the very upper edge of the pancreas and the first layer suture was finished
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940953&req=5

Fig4: A knot was tied at the very upper edge of the pancreas and the first layer suture was finished
Mentions: The patients were sufficiently physiologically and psychologically prepared before the operations. During the operations, the transfixations of the upper and lower edges of the stump of the pancreas were emphasized to decrease blood loss before the transection of the pancreas. A pancreatic duct stent was used to the fix the stump of pancreas for at least 15 cm to drain the pancreatic jaundice to the distal end of the jejunum and was placed at least 10 cm away from the anastomosis of the cholangioenterostomy. The stump of the jejunum was pulled to the stump of the pancreas behind the transverse mesocolon without tension. The stump of the pancreas was invaginated into the jejunum by at least 2–3 cm and fixed with 3-0 polypropylene suture (Prolene, Ethicon). The difference between the continuous suturing and interrupted suturing was limited to the procedure of suturing the pancreaticoenterostomy. The interrupted suturing involved one layer of discontinuous sutures with distances of 2–3 mm between each pair of stitches. The continuous suturing involved one layer posteriorly and two layers anteriorly. A 3-0 polypropylene suture was used to complete the suturing from the very upper edge of the pancreas to the lower edge through the posterior edge of the pancreas, and the anterior suture was then completed with the suture. Finally, a knot was tied at the upper edge of the pancreas with the very end of the suture (Figs. 1, 2, 3 and 4). After the first-layer suture, a second-layer suture was applied from at the end edge of the lateral opening of the jejunum anteriorly from the very lower edge of the pancreas to the very upper edge (Fig. 5).Fig. 1

Bottom Line: Although the total operation times were not reduced, the suturing time for the pancreaticoenterostomies in the continuous suture group (11.3 ± 1.8 min) was greatly reduced compared with that for the interrupted suture group (14.1 ± 2.9 min, p = 0.045).Importantly, the continuous mattress suturing method significantly decreased short-term post-operative complications, including pancreatic leakage (p = 0.042).Continuous mattress suturing is a safe and effective pancreaticoenterostomy method that leads to reduced complications and hospitalization times.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471003, People's Republic of China.

ABSTRACT

Background: Most complications after pancreaticoduodenectomy (PD) were relation to pancreaticoenterostomy. We improved a new method of pancreaticoenterostomy that included the continuous suturing of the jejunum and the stump of the pancreas end-to-side with one layer posteriorly and two layers anteriorly. To evaluate the safety and efficiency of this new method, we introduced this retrospectively compared trial.

Methods: We compared 45 patients who had undergone pancreaticoduodenectomy with either the regular interrupted suturing method or the new continuous mattress suturing method in our hospital from September 2011 to March 2014.

Results: Although the total operation times were not reduced, the suturing time for the pancreaticoenterostomies in the continuous suture group (11.3 ± 1.8 min) was greatly reduced compared with that for the interrupted suture group (14.1 ± 2.9 min, p = 0.045). Importantly, the continuous mattress suturing method significantly decreased short-term post-operative complications, including pancreatic leakage (p = 0.042). Furthermore, shorter hospitalization times were observed in the continuous mattress suture group (12.3 ± 5.0 d) than in the interrupted suture group (24.2 ± 11.6 d, p = 0.000).

Conclusions: Continuous mattress suturing is a safe and effective pancreaticoenterostomy method that leads to reduced complications and hospitalization times.

No MeSH data available.


Related in: MedlinePlus