Invaginating Pancreaticojejunostomy: How I Do It
Pancreaticoduodenectomy (PD) is a surgical procedure designed to treat benign and malignant diseases of the periampullary region such as chronic pancreatitis and pancreatic cancer. The operation is conducted in two parts, the first of which is the extirpative phase, which includes the removal of the pancreatic head, neck, and uncinate process, distal common bile duct, and duodenum. This is followed by the reconstruction phase where the duodenum, bile duct, and pancreas remnant are anastomosed to the jejunum. The technique for the pancreaticojejunostomy (PJ) anastomosis will be the subject of this chapter.
The PJ is often termed the “Achilles heel” of the operation because it is the aspect associated with the highest occurrence of leakage and the ensuing potential for intra-abdominal sepsis. Leakage of the PJ is also a driver of a variety of other associated complications, such as delayed gastric emptying, intestinal ileus, and wound infection, among others. The two most common techniques in current practice for PJ construction are the invaginated and the duct-to-mucosa anastomoses. Despite a series of prospective, randomized controlled trials, there continues to be a lack of consensus among surgeons as to which method provides the best outcome for patients.
KeywordsPancreaticoduodenectomy (PD) Pancreaticojejunostomy (PJ) Pancreaticogastrostomy (PG) Invaginated pancreaticojejunostomy Allen Oldfather Whipple Pylorus-preserving PJ Postoperative pancreatic fistula (POPF)
- 2.Sauve L. Des pancreatectomies et spécialment de la pancréatectomie céphalique. Rev Chir. 1908;37:113–52, and 335-85Google Scholar
- 3.Kausch W. Das Carcinom der Papilla duodeni und seine radikale Entfernung. Beitrage zur Klinische. Chirurgie. 1912;78:439–86.Google Scholar
- 4.Dragstedt LR, Dragstedt C, McClintock JT, Chase CS. Extirpation of the duodenum. Am J Physiol. 1918;46:584–90.Google Scholar
- 14.Lavu H, Brumbaugh J, Yeo CJ. Pylorus-preserving pancreaticoduodenectomy with invaginating pancreaticojejunostomy. In: Asbun HJ, Fuchshuber PR, editors. ACS multimedia atlas of surgery: pancreas surgery volume. 1st ed. Woodbury: Cine-Med; 2016.Google Scholar
- 15.Lavu H. Invaginated pancreaticojejunostomy (Whipple Reconstruction) by Harish Lavu | CSurgeries [Internet]. Csurgeries.com. 2016 [cited 31 December 2016]. https://www.csurgeries.com/video/invaginated-pancreaticojejunostomy-(whipple-reconstruction)/ouyyb9jyj1