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“True” Duct-to-Mucosa Pancreaticojejunostomy, with Secure Eversion of the Enteric Mucosa, in Whipple Operation

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call “true” duct-to-mucosa anastomosis (DMA)—pancreaticojejunostomy.

Methods

A novel enteric mucosal eversion at the point of the jejunostomy is constructed prior to the anastomosis with the pancreatic duct in order to enhance sealing. This technique was tested in a series of 38 patients (study group) and compared to the technique used in the preceding 35 patients who served as controls.

Results

The incidence of POPF was significantly lower in the study group compared to controls: 7.9 % (3/38) vs 34.3 % (12/35), respectively (P = 0.008, odds ratio 6.1). All POPFs in the study group were International Study Group on Pancreatic Fistula (ISGPF) grade A, while in the control group POPFs ISGPF grade B and C occurred in 17.1 %. Additionally, median (interquartile range) postoperative hospitalization was reduced in the study group [16 (14–21) days] compared to controls [20 (16–27) days, P = 0.005].

Conclusions

The “true” DMA technique appears to be one of the safest techniques reported to date. The modifications presented herein can easily be adopted by experienced surgeons already performing other techniques of duct-to-mucosa anastomosis.

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Acknowledgments

The authors would like to thank Nancy Mead, MSc, PhD for editing the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Patras Medical School, Patras, Greece

    Dionissios D. Karavias, Dimitrios D. Karavias, Ioannis G. Chaveles, Stavros K. Kakkos, Nicolaos A. Katsiakis & Ioannis C. Maroulis

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  1. Dionissios D. Karavias
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  2. Dimitrios D. Karavias
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Correspondence to Dionissios D. Karavias.

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Karavias, D.D., Karavias, D.D., Chaveles, I.G. et al. “True” Duct-to-Mucosa Pancreaticojejunostomy, with Secure Eversion of the Enteric Mucosa, in Whipple Operation. J Gastrointest Surg 19, 498–505 (2015). https://doi.org/10.1007/s11605-014-2709-8

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