Annals of Surgical Oncology

, Volume 21, Issue 13, pp 4336–4341 | Cite as

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

  • Xiao-ping ChenEmail author
  • Zhi-yong Huang
  • Josef W. Y. Lau
  • Bi-xiang Zhang
  • Zhi-wei Zhang
  • Yi-fa Chen
  • Wan-guang Zhang
  • Peng Zhu
  • Binhao Zhang
Pancreatic Tumors


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.


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.


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.


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.


Pancreatic Duct Pancreatic Fistula Jejunum Loop Pancreatic Stump Postoperative Pancreatic Fistula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

Supplementary material 1 (MPG 44582 kb)

Video 1

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

Video 2

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

Video 3

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


  1. 1.
    Wolfgang CL, Pawlik TM. Pancreaticoduodenectomy: time to change our approach? Lancet Oncol. 2013;14:573–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Heeger K, Fendrich V, Waldmann J, Langer P, Kanngießer V, Bartsch DK. Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy. Surgeon. 2013;11:246–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Topal B, Aerts R, Hendrickx T, Fieuws S, Penninckx F. Determinants of complications in pancreaticoduodenectomy. Eur J Surg Oncol. 2007;33:488–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Bassi C, Falconi M, Molinari E, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767–73.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Ke S, Ding XM, Gao J, et al. A prospective, randomized trial of Roux-en-Y reconstruction with isolated pancreatic drainage versus conventional loop reconstruction after pancreaticoduodenectomy. Surgery. 2013;153:743–52.PubMedCrossRefGoogle Scholar
  7. 7.
    de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg. 2005;92:1117–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, Lui WY. Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. J Formos Med Assoc. 2007;106:717–27.PubMedCrossRefGoogle Scholar
  9. 9.
    Govindarajan A, Tan JC, Baxter NN, Coburn NG, Law CH. Variations in surgical treatment and outcome of patients with pancreatic cancer: a population-based study. Ann Surg Oncol. 2008;15:175–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Greene BS, Loubeau JM, Peoples JB, Elliott DW. Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg. 1991;161:45–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Hines OJ, Reber HA. Technique of pancreaticojejunostomy reconstruction after pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg. 2006;13:185–9.PubMedCrossRefGoogle Scholar
  12. 12.
    House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Ibrahim S, Tay KH, Launois B, Ta NC. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Dig Surg. 2006;23:296–302.PubMedCrossRefGoogle Scholar
  14. 14.
    Katsaragakis S, Antonakis P, Konstadoulakis MM, Androulakis G. Reconstruction of the pancreatic duct after pancreaticoduodenectomy : a modification of the Whipple procedure. J Surg Oncol. 2001;77:26–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen XP, Zhang ZW, Zhang BX, Chen YF, Huang ZY. A technique of end-to-end invaginated pancreaticojejunostomy with double transpancreatic U-sutures after Whipple procedure. Chin J Surg. 2007;45:355–6.Google Scholar
  16. 16.
    Chen XP, Qiu FZ, Zhang ZW, Chen YF, Huang ZY, Zhang WG. 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. 2009;394:739–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Oneil Machado N. Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management: review. Int J Surg Oncol. 2012;2012:1–10.Google Scholar
  19. 19.
    Samra JS, Bachmann RA, Choi J, et al. One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach. Hepatobiliary Pancreat Dis Int. 2011;10:415–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Ma JP, Peng L, Qin T, et al. Meta-analysis of pancreaticoduodenectomy prospective controlled trials: pancreaticogastrostomy versus pancreaticojejunostomy reconstruction. Chin Med J. 2012;125(21):3891–7.PubMedGoogle Scholar
  21. 21.
    Peng SY, Wang WW, Lau WY, Cai XJ, Mou YP, Liu YB, et al. Conventional versus binding pancreaticojejunostomy after pancreaticduodenectomy a prospective randomized trial. Ann Surg. 2007;245:692–8.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Mehta VV, Fisher SB, Maithel SK, Sarmiento JM, Staley CA, Kooby DA. Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies. Am Coll Surg. 2013;216:635–44.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Xiao-ping Chen
    • 1
    Email author
  • Zhi-yong Huang
    • 1
  • Josef W. Y. Lau
    • 1
  • Bi-xiang Zhang
    • 1
  • Zhi-wei Zhang
    • 1
  • Yi-fa Chen
    • 1
  • Wan-guang Zhang
    • 1
  • Peng Zhu
    • 1
  • Binhao Zhang
    • 1
  1. 1.Department of Surgery, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

Personalised recommendations