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Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy

  • Pancreatic Tumors
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Abstract

Background and Purpose

Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging. This study aims to review a new surgical approach, the Chen’s U-stitch technique, for end-to-end invaginated pancreaticojejunostomy, which involves two to four transpancreatic transverse U-sutures, and to evaluate the effectiveness of this approach with reducing the incidence of POPF formation.

Methods

To evaluate this new approach, during 2002–2012, a total of 264 patients who received the new Chen’s U-stitch technique after a PD were included in this study. Postoperative morbidity and mortality, including the incidence of POPF, were analyzed.

Results

Postoperative morbidity was 22.3 % (59/264) and mortality was 0 % (0/264). The POPF rate was 3.4 % (9/264) for Grade A, 0.8 % (2/264) for Grade B, and 0 % (0/264) for Grade C.

Conclusions

This new surgical technique (Chen’s U-stitch), which involves an end-to-end invaginated pancreaticojejunostomy with two to four transpancreatic transverse U-sutures, provides excellent outcomes at reducing the incidence of POPF after PD.

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Acknowledgment

This work was supported by the State key project on inflectional disease of China (Grant numbers 2012ZX10002016-004 and 2012ZX10002010-001-004), the Chinese Ministry of Public Health for Key Clinical Projects (no. 439, 2010) to Professor Xiao-ping Chen.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Xiao-ping Chen MD, FACS, FASA (hoc), Zhi-yong Huang MD, Josef W. Y. Lau MD, Bi-xiang Zhang MD, Zhi-wei Zhang MD, Yi-fa Chen MD, Wan-guang Zhang MD, Peng Zhu MD & Binhao Zhang MD

Authors
  1. Xiao-ping Chen MD, FACS, FASA (hoc)
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  2. Zhi-yong Huang MD
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  3. Josef W. Y. Lau MD
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  4. Bi-xiang Zhang MD
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  5. Zhi-wei Zhang MD
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  6. Yi-fa Chen MD
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  7. Wan-guang Zhang MD
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  8. Peng Zhu MD
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  9. Binhao Zhang MD
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Corresponding author

Correspondence to Xiao-ping Chen MD, FACS, FASA (hoc).

Electronic supplementary material

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Supplementary material 1 (MPG 44582 kb)

Single-needle U-suture technique (cartoon) (WMV 15988 kb)

Two-needle U-suture technique (cartoon) (AVI 11483 kb)

Two-needle U-suture technique (operative demonstration) (WMV 189946 kb)

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Chen, Xp., Huang, Zy., Lau, J.W.Y. et al. Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy. Ann Surg Oncol 21, 4336–4341 (2014). https://doi.org/10.1245/s10434-014-3823-2

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  • DOI: https://doi.org/10.1245/s10434-014-3823-2

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