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Prospective Randomized Comparison between a New Mattress Technique and Cattell (duct-to-mucosa) Pancreaticojejunostomy for Pancreatic Resection

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Abstract

The majority of lethal complications after pancreatic head resection are due to septic complications after leakage from the pancreatojejunostomy. Especially the smooth pancreatic remnant is prone to develop parenchymal leaks from shear forces applied during tying of the sutures. We developed a new mattress technique that avoids such shear forces, and we compared this method to the standard Cattell (duct-to-mucosa) technique. A total of 113 patients undergoing standard pancreatic head resection were prospectively randomized to receive either the standard Cattell anastomosis (n = 56) or the new mattress technique (n = 57). All patients were evaluated for surgical and medical complications until discharge. Primary diagnosis and further demographic data compared well between the groups. The time to perform the mattress anastomosis was significantly shorter (15 vs. 22 minutes; p < 0.0001). The incidence of complications at the pancreatojejunostomy, and the length of hospital stay and survival were not significantly different between the two groups; however, a trend toward more reoperations was noted in the Cattell group (10 vs. 5; p < 0.097). The new mattress technique is simple, and our data show that the two techniques yield similar incidences of complications. Therefore the mattress technique for pancreatojejunostomy seems to be safe and is, in our opinion, well suitable for training schedules in pancreatic surgery.

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References

  1. Kausch W. Das Carcinom der papilla duodeni und seine radikale Entfernung. Beiträge zur klinischen Chirurgie 1912;78:439

    Google Scholar 

  2. Whipple AO, Parsons WB, Mullins CR. Treatment of cancer of the ampulla of Vater. Ann. Surg. 1935;102:763

    Google Scholar 

  3. Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg. Gynecol. Obstet. 1978;146:959

    PubMed  Google Scholar 

  4. Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann. Surg. 1993;217:430

    PubMed  Google Scholar 

  5. Andersen HB, Baden H, Bille Brahe NE, et al. Pancreaticoduodenectomy for periampullary adenocarcinoma. Am. J. Coll. Surg. 1994;179:545

    Google Scholar 

  6. Shyr YM, Su CH, Wang HC, et al. Comparison of resectable and unresectable periampullary carcinomas. Am. J. Coll. Surg. 1994;178:369

    Google Scholar 

  7. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann. Surg. 1997;226:248

    Article  PubMed  Google Scholar 

  8. Idezuki Y, Goetz FC, Lillehei RC. Late effect of pancreatic duct ligation on beta cell function. Am. J. Surg. 1969;117:33

    Article  PubMed  Google Scholar 

  9. Papachristou DN, Fortner JG. Pancreatic fistula complicating pancreatectomy for malignant disease. Br. J. Surg. 1981;68:238

    PubMed  Google Scholar 

  10. Zuhlke HV, Haring R, Waterman UJ, et al. Leistungsbilanz der Inselzellen nach Pankreasgangocclusion-ein Langzeitversuch. [Functional evaluation of islet cells following pancreatic duct occlusion - a long-term study]. Langenbecks Arch. Chir. 1983;360:141

    Article  PubMed  Google Scholar 

  11. Tashiro S, Murata E, Hiraoka T, et al. New technique for pancreaticojejunostomy using a biological adhesive. Br. J. Surg. 1987;74:392

    PubMed  Google Scholar 

  12. Gall FP, Gebhardt C, Meister R, et al. Severe chronic cephalic pancreatitis: use of partial duodenopancreatectomy with occlusion of the pancreas duct in 289 patients. World J. Surg. 1989;13:809

    Article  PubMed  Google Scholar 

  13. Waclawiczek HW, Lorenz D. Der Schutz der pancreatico-digestiven Anastomose nach Pankreaskopfresektion durch Pankreasgangocclusion mit Fibrin (-kleber). Chirurg 1989;60:403

    PubMed  Google Scholar 

  14. Buchler M, Friess H, Klempa I, et al. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am. J. Surg. 1992;163:125

    Article  PubMed  Google Scholar 

  15. Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann. Surg. 2000;232:419

    Article  PubMed  Google Scholar 

  16. Kech H, Steffen R, Neuhaus P. Protection of pancreatic and biliary anastomosis after duodenopancreatectomy by external drainage. Surg. Gynecol. Obstet. 1992;174:329

    PubMed  Google Scholar 

  17. Trede M, Saeger HD, Schwall G, et al. Resection of pancreatic cancer—surgical achievements. Langenbecks Arch. Surg. 1998;383:121

    PubMed  Google Scholar 

  18. Biehl T, Traverso LW. Is stenting necessary for a successful pancreatic anastomosis? Am. J. Surg. 1992;163:530

    Article  PubMed  Google Scholar 

  19. Yoshimi F, Ono H, Asato Y, et al. Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital. Surg. Today 1996;26:665

    Article  PubMed  Google Scholar 

  20. Matsumoto Y, Fujii H, Miura K, et al. Successful pancreatojejunal anastomosis for pancreatoduodenectomy. Surg. Gynecol. Obstet. 1992;175:555

    PubMed  Google Scholar 

  21. Tondelli P. Drainagen in der biliopankreatischen Chirurgie. [Drainage in biliopancreatic surgery]. Helv. Chir. Acta 1979;46:573

    PubMed  Google Scholar 

  22. Roder JD, Stein HJ, Böttcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy. A prospective study, Am. Surg. 1999;229:41

    Google Scholar 

  23. Cattell RB. A technic for pancreatoduodenal resection, Surg. Clin. North Am. 1948;28:761

    Google Scholar 

  24. Funovics JM, Zöch G, Wenzel E, et al. Progress in reconstruction after resection of the head of the pancreas Surg. Gynecol. Obstet. 164:545, 1987

    PubMed  Google Scholar 

  25. Peiper HJ, Hollender F. Chirurgische Therapie der chronischen Pankreatitis. In Hollender F, Peiper HJ, editors, Pankreaschirurgie. Springer Verlag, Berlin, New York, 1988;277–321

  26. Braasch JW, Gagner M. Pylorus-preserving pancreatoduodenectomy—technical aspects. Langenbecks Arch. Chir. 1991;376:50

    Article  PubMed  Google Scholar 

  27. Kojima Y, Katayama K, Note M, et al. Pancreaticojejunostomy and pancreatic leakage after pancreaticoduodenectomy. Int. Surg. 1992;77:80

    PubMed  Google Scholar 

  28. Nagakawa T. Modified pancreatic invagination into the jejunum with a double intestinal segment—a new technique. Hepato-Gastroenterology 1992;39:70

    PubMed  Google Scholar 

  29. Hiraoka T, Kamenitsu K, Tsuji T, et al. A method of safe pankreaticojejunostomy. Am. J. Surg. 1993;165:270

    PubMed  Google Scholar 

  30. Kingsnorth AN. Safety and function of isolated Roux loop pancreaticojejunostomy after Whipple’s pancreaticoduodenectomy. Ann. R. Coll. Surg. Engl. 1994;76:175

    PubMed  Google Scholar 

  31. Sing RF, Reilly PM, Schwab CW. The single-layered, parachuted intussuscepted pancreaticojejunostomy. Am. Surg. 1995;61:322

    PubMed  Google Scholar 

  32. Brewer MS. Management of the pancreatic stump during the Whipple operations. Am. J. Surg. 1996;171:438

    Article  PubMed  Google Scholar 

  33. Howard JM. Pancreatojejunostomy: leakage is a preventable complication of the Whipple resection. J. Am. Coll. Surg. 1997;184:454

    PubMed  Google Scholar 

  34. D’Amato A, Montesani C, Casagrande M, et al. End to side mucomucosal Wirsung jejunostomy after pancreaticoduodenectomy: immediate results and long term follow-up. Hepatogastroenterology 1998;45:1135

    PubMed  Google Scholar 

  35. Keck H, Steffen R, Neuhaus P. Protection of pancreatic and biliary anastomosis after partial duodenopancreatectomy by external drainage. Surg. Gynecol. Obstet. 1992;174:329

    PubMed  Google Scholar 

  36. Trede M. Technik der Duodenopankreatektomie nach Whipple. Chirurg 1994;65:232

    PubMed  Google Scholar 

  37. Cattell RB. Resection of the pancreas: discussion of special problems. S. Clin. North Am. 1943;23:53

    Google Scholar 

  38. Nagakawa T, Konishi I, Ueno K, et al. A comparison of the complication rate for three pancreaticojejunostomy techniques. Hepatogastroenterology 1997;44:1452

    PubMed  Google Scholar 

  39. Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients. Surgery 1998 123:617

    PubMed  Google Scholar 

  40. Büchler MW, Friess H, Wagner M, et al. Pancreatic fistula after pancreatic head resection. Br. J. Surg. 2000;87:883

    Article  PubMed  Google Scholar 

  41. Yeo CJ, Cameron JL. Improving results of pancreaticoduodenectomy for pancreatic cancer. World J. Surg. 1999;23:907

    Article  PubMed  Google Scholar 

  42. Henne-Bruns D, Vogel I, Lüttges J, et al. Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications, and survival after regional versus extended lymphadenectomy. World J. Surg. 2000;24:595

    Article  PubMed  Google Scholar 

  43. Chikh-Torab F, Shugaa A, Schoenberg MH, et al. Die Cattell-Warren Anastomose im weichen Restpankreas nach Pankreasresektionen. Langenbeck’s Arch. Chir. 1996;Suppl II:249

  44. Braasch JW, Rossi RL, Watkins E, Jr, et al. Pyloric and gastric preserving pancreatic resection. Ann. Surg. 1986;204:411

    PubMed  Google Scholar 

  45. Braasch JW, Gagner M. Pylorus-preserving pancreatoduodenectomy-technical aspects. Langenbeck’s Arch. Chir. 1991;376:50

    Google Scholar 

  46. Mongé JJ, Judd ES, Gage RP. Radical pancreatoduodenectomy: a 22-year experience with the complications, mortality rate, and survival rate. Ann. Surg. 1964;160:711

    PubMed  Google Scholar 

  47. Teichmann W, Herbig B. Die Pankreatogastrostomie als Modifikation der Whipple’schen Operation. Chir. Gastroenterol 1989;5:379

    Google Scholar 

  48. Schlitt HJ, Schmidt U, Simunec D, et al. Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br. J. Surg. 2002;89:1245

    Article  PubMed  Google Scholar 

  49. Goldsmith HS, Ghosh BC, Huvos AG. Ligation versus implantation of the pancreatic duct after pancreaticoduodenectomy. Surg. Gynecol Obstet. 1971;132:87

    PubMed  Google Scholar 

  50. Grace PA, Pitt HA, Tompkins RK, et al. Decreased morbidity and mortality after pancreatoduodenectomy. Am. J. Surg. 1986;151:141

    Article  PubMed  Google Scholar 

  51. Waclawiczek HW, Boeckl O. Die Wertigkeit der additiven Anastomosen-bzw. Nahtversiegelung mit Fibrinkleber am Gastrointestinaltrakt. Akt. Chir. 1988;23:17

    Google Scholar 

  52. Friess H, Beger HG, Sulkowski U, et al. Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br. J. Surg. 1995;82:1270

    PubMed  Google Scholar 

  53. Montorsi M, Zago M, Mosca F, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 1995;117:26

    PubMed  Google Scholar 

  54. Suzuki Y, Kuroda Y, Morita A, et al. Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch. Surg. 1995;130:952

    PubMed  Google Scholar 

  55. Traverso LW, Tompkins RK, Urrea PT, et al. Surgical treatment of chronic pancreatitis. Twenty-two years experience. Am. Surg. 1979;190:312

    Google Scholar 

  56. Aretxabala De X, Burgos L, Flores P. Pancreatojejunostomy. Am. Surg. 1991;57:293

    PubMed  Google Scholar 

  57. Schoretsanitis GN, Tsiftsis DD, Tatoulis PA, et al. Pancreaticoduodenectomy with external drainage of the residual pancreatic duct. Eur. J. Surg. 1993;159:421

    PubMed  Google Scholar 

  58. Hamanaka Y, Suzuki T. Total pancreatic duct drainage for leakproof pancreatojejunostomy. Surgery 1994;115:22

    PubMed  Google Scholar 

  59. Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann. Surg. 1999;229:41

    Article  PubMed  Google Scholar 

  60. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann. Surg. 1990;211:447

    PubMed  Google Scholar 

  61. Klinkenbijl JH, van der Schelling GP, Hop WC, et al. The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region. Ann. Surg. 1992;216:142

    PubMed  Google Scholar 

  62. Yeo CJ. Management of complications following pancreaticoduodenectomy. Surg. Clin. North Am. 1995;75:913

    PubMed  Google Scholar 

  63. Patel AG, Toyama MT, Kusske AM, et al. Pylorus-preserving Whipple resection for pancreatic cancer, Arch. Surg. 1995;130:838

    PubMed  Google Scholar 

  64. Lowy AM, Lee JE, Pisters PW, et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease, Ann. Surg. 1997;226:632

    Google Scholar 

  65. Rumstadt B, Forssmann K, Singer MV, et al. The Whipple partial duodenopancreatectomy for the treatment of chronic pancreatitis. Hepatogastroenterology 1997;44:1554

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral and Transplanation Surgery, Charité Campus Vichow-Klinikum, Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Jan M. Langrehr M.D., Marcus Bahra M.D., Dietmar Jacob M.D., Matthias Glanemann M.D. & Peter Neuhaus M.D.

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  1. Jan M. Langrehr M.D.
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  2. Marcus Bahra M.D.
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  3. Dietmar Jacob M.D.
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Correspondence to Jan M. Langrehr M.D..

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Langrehr, J.M., Bahra, M., Jacob, D. et al. Prospective Randomized Comparison between a New Mattress Technique and Cattell (duct-to-mucosa) Pancreaticojejunostomy for Pancreatic Resection. World J. Surg. 29, 1111–1119 (2005). https://doi.org/10.1007/s00268-005-7875-0

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