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A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

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An Erratum to this article was published on 11 October 2009

Abstract

Background

Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreato-enteric anastomosis after PD have been proposed to reduce POPF rate. Until now, there is no consensus on which is the best. This study presents a new technique of the end-to-end invaginated pancreaticojejunostomy with two to three transpancreatic U-sutures and evaluates its safety and reliability.

Material and methods

From 2002 to 2007, 88 patients (54 men and 34 women) underwent an invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures after PD. The mean age was 52.4 years (range, 26–74 years). The diseases of the all patients were malignant.

Results

In all patients of this study, two transpancreatic U-sutures were performed in 59 and three U-sutures in 29. The median duration of surgery was 3.8 h (range 3–6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range 8–25). The median blood loss was 750 ml (range 300–1,800), 36 patients needed transfusion and the median blood transfusion was 380 mL (range 200–1,200). Overall morbidity occurred in 15 patients (17.0%). Only two patients (2.2%) had grade A of POPF and no patient had grade B and grade C of POPF. No operative death occurred.

Conclusions

An invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures is simple, rapid, safe, and reliable technique, even in some patients with soft pancreas and small pancreatic duct.

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Abbreviations

POPF:

postoperative pancreatic fistula

PD:

pancreaticoduodenectomy

References

  1. Bartoli FG, Arnone GB, Ravera G, Bachi V (1991) Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res 11(5):1831–1848

    PubMed  CAS  Google Scholar 

  2. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. doi:10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  3. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, Salvia R, Pederzoli P (2003) Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 134(5):766–771. doi:10.1016/S0039-6060(03) 00345-3

    Article  PubMed  Google Scholar 

  4. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P (2005b) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242(6):767–771. doi:10.1097/01.sla.0000189124.47589.6d discussion 771–3

    Article  Google Scholar 

  5. Benzoni E, Zompicchiatti A, Saccomano E, Lorenzin D, Baccarani U, Adani G, Noce L, Uzzau A, Cedolini C, Bresadola F et al (2008) Postoperative complications linked to pancreaticoduodenectomy. An analysis of pancreatic stump management. J Gastrointestin Liver Dis 17(1):43–47

    PubMed  Google Scholar 

  6. Chen XP, Zhang ZW, Zhang BX, Chen YF, Huang ZY (2007) A techinique of end-to-end invaginated pancreaticjejunostomy with double transpancreatic U-sutures after whipple procedure. Chin J Surg 45:355–356

    Google Scholar 

  7. de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ (2005) Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg 92(9):1117–1123. doi:10.1002/bjs.5047

    Article  PubMed  Google Scholar 

  8. Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, Lui WY (2007) Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. J Formos Med Assoc 106(9):717–727. doi:10.1016/S0929-6646(08) 60033-9

    Article  PubMed  Google Scholar 

  9. Govindarajan A, Tan JC, Baxter NN, Coburn NG, Law CH (2008) Variations in surgical treatment and outcomes of patients with pancreatic cancer: a population-based study. Ann Surg Oncol 15(1):175–185. doi:10.1245/s10434-007-9601-7

    Article  PubMed  Google Scholar 

  10. Greene BS, Loubeau JM, Peoples JB, Elliott DW (1991) Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg 16(1):45–49. doi:10.1016/0002-9610(91)90359-L discussion 49–50

    Article  Google Scholar 

  11. Hines OJ, Reber HA (2006) Technique of pancreaticojejunostomy reconstruction after pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 13:185–189

    Article  PubMed  Google Scholar 

  12. House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF et al (2008) Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 12(2):270–278. doi:10.1007/s11605-007-0421-7

    Article  PubMed  Google Scholar 

  13. Ibrahim S, Tay KH, Launois B, Ta NC (2006) Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Dig Surg 23(5–6):296–302. doi:10.1159/000096244

    Article  PubMed  Google Scholar 

  14. Katsaragakis S, Antonakis P, Konstadoulakis MM, Androulakis G (2001) Reconstruction of the pancreatic duct after pancreaticoduodenectomy: a modification of the Whipple procedure. J Surg Oncol 77(1):26–29. doi:10.1002/jso.1060 discussion 30

    Article  PubMed  CAS  Google Scholar 

  15. Kazanjian KK, Hines OJ, Eibl G, Reber HA (2005) Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. Arch Surg 140(9):849–854. doi:10.1001/archsurg.140.9.849 discussion 854–6

    Article  PubMed  Google Scholar 

  16. Khan AW, Agarwal AK, Davidson BR (2002) Isolated Roux Loop duct-to-mucosa pancreaticojejunostomy avoids pancreatic leaks in pancreaticoduodenectomy. Dig Surg 19(3):199–204. doi:10.1159/000064213

    Article  PubMed  Google Scholar 

  17. Lee SE, Yang SH, Jang JY, Kim SW (2007) Pancreatic fistula after pancreaticoduodenectomy: a comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: interrupted vs continuous stitches. World J Gastroenterol 13(40):5351–5356

    PubMed  Google Scholar 

  18. Marcus SG, Cohen H, Ranson JH (1995) Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 221(6):635–645. doi:10.1097/00000658-199506000-00003 discussion 645–8

    Article  PubMed  CAS  Google Scholar 

  19. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, Nakeeb A, Zyromski NJ, Lillemoe KD (2007) Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 246(6):1058–1064

    Article  PubMed  Google Scholar 

  20. Matsumoto Y, Fujii H, Miura K, Inoue S, Sekikawa T, Aoyama H, Ohnishi N, Sakai K, Suda K (1992) Successful pancreatojejunal anastomosis for pancreatoduodenectomy. Surg Gynecol Obstet 175(6):555–562

    PubMed  CAS  Google Scholar 

  21. Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K (2007) Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 14(6):557–563. doi:10.1007/s00534-007-1242-5

    Article  PubMed  Google Scholar 

  22. Oussoultzoglou E, Bachellier P, Bigourdan JM, Weber JC, Nakano H, Jaeck D (2004) Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 139(3):327–335. doi:10.1001/archsurg.139.3.327

    Article  PubMed  Google Scholar 

  23. Peng SY, Mou YP, Liu YB, Su Y, Peng CH, Cai XJ, Wu YL, Zhou LH (2003) Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg 7(7):898–900. doi:10.1007/s11605-003-0036-6

    Article  PubMed  Google Scholar 

  24. Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246(3):425–433. doi:10.1097/SLA.0b013e3181492c28 discussion 433–5

    Article  PubMed  Google Scholar 

  25. Reissman P, Perry Y, Cuenca A, Bloom A, Eid A, Shiloni E, Rivkind A, Durst A (1995) Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma. Am J Surg 169(6):585–588. doi:10.1016/S0002-9610(99) 80226-8

    Article  PubMed  CAS  Google Scholar 

  26. Schell MTBA, Spitzer AL, Harris HW (2008) Pancreaticoduodenectomy: volume is not associated with outcome within an academic health care system. HPB Surg :1–6. doi:10.1155/2008/825940

  27. Shrikhande SV, Barreto G, Shukla PJ (2008) Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy. Langenbecks Arch Surg 393(1):87–91. doi:10.1007/s00423-007-0221-2

    Article  PubMed  Google Scholar 

  28. Shrikhande SV, Qureshi SS, Rajneesh N, Shukla PJ (2005) Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World J Surg 29(12):1642–1649. doi:10.1007/s00268-005-0137-3

    Article  PubMed  Google Scholar 

  29. Strasberg SM, Drebin JA, Mokadam NA, Green DW, Jones KL, Ehlers JP, Linehan D (2002) Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 194(6):746–758. doi:10.1016/S1072-7515(02)01202-4 discussion 759–60

    Article  PubMed  Google Scholar 

  30. Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S (2000) Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 87(4):423–427. doi:10.1046/j.1365-2168.2000.01395.x

    Article  PubMed  CAS  Google Scholar 

  31. Tran K, Van Eijck C, Di Carlo V, Hop WC, Zerbi A, Balzano G, Jeekel H (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236(4):422–428. doi:10.1097/00000658-200210000-00004 discussion 428

    Article  PubMed  Google Scholar 

  32. Wente MN, Shrikhande SV, Muller MW, Diener MK, Seiler CM, Friess H, Buchler MW (2007) Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 193(2):171–183. doi:10.1016/j.amjsurg.2006.10.010

    Article  PubMed  Google Scholar 

  33. Zeng Q, Zhang Q, Han S, Yu Z, Zheng M, Zhou M, Bai J, Jin R (2008) Efficacy of somatostatin and its analogues in prevention of postoperative complications after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Pancreas 36(1):18–25

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Prof. Hans G. Beger, Department of Surgery, Ulm University, Germany, for his support in this study and revision of this paper. This study was supported by a grant (No.353, [2007]) from the Clinical Key Projects of the Ministry of Health, China, and the Clinical Key Projects of Hepatic Surgery Research Centre of Hubei, China (2007).

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Authors and Affiliations

  1. Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, People’s Republic of China

    Xiao-Ping Chen, Fa-Zu Qiu, Zhi-Wei Zhang, Yi-Fa Chen, Zhi-Yong Huang & Wan-Guang Zhang

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  1. Xiao-Ping Chen
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Correspondence to Xiao-Ping Chen.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00423-009-0559-8

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Chen, XP., Qiu, FZ., Zhang, ZW. et al. A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases. Langenbecks Arch Surg 394, 739–744 (2009). https://doi.org/10.1007/s00423-009-0487-7

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