Advertisement

Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 19, Issue 2, pp 116–124 | Cite as

Stented pancreaticojejunostomy (with video)

  • Yoshinori AzumiEmail author
  • Shuji Isaji
Topics Highly advanced surgery in the hepatobiliary and pancreatic field (Pancreatic Chapter)

Abstract

Background/purpose

Using a standardized technique for pancreaticojejunostomy that we term “pair-watch suturing technique”, we prospectively analyzed the effects of a pancreatic stent tube for preventing pancreatic fistula and furthermore evaluated which perioperative factors had an influence on the development of pancreatic fistula.

Operative procedure

Before anastomosis, we imagine the faces of a pair of wristwatches on the jejunal hole and pancreatic duct. The first stitch was put between 9 o’clock on the pancreatic side and 3 o’clock on the jejunal side, and a total of 7 stitches were put in the posterior wall, followed by 5 stitches in the anterior wall. Using this technique, twelve stitches can be sutured in the first layer anastomosis regardless of the caliber of the pancreatic duct.

Patients and methods

From March 2007 to April 2009, 55 consecutive patients who underwent the pair-watch suturing technique were divided into two groups: stent (n = 28) and no-stent (n = 27). The incidence rate of pancreatic fistula was statistically analyzed. From March 2007 to March 2011, 102 consecutive patients were retrospectively divided into two groups according to the International Study Group on Pancreatic Fistula criteria: postoperative pancreatic fistula (POPF) and non-POPF.

Results

Perioperative factors were almost the same between the stent and no-stent groups, and the incidence of pancreatic fistula was very similar: 10.7% in the stent group and 14.8% in the no-stent group. Additionally, all patients who developed pancreatic fistula belonged to grade A. Among 102 patients, 15 (14.7%) were identified as having pancreatic fistula: 9 (8.8%) in grade A, 5 (4.9%) in grade B, and 1 (0.9%) in grade C. Comparing the POPF and non-POPF groups, we could not detect any significant risk factors for the development of pancreatic fistula.

Conclusion

We consider that the pair-watch suturing technique is less susceptible to any factors, providing reliable anastomosis for any size of pancreatic duct and any texture of remnant pancreas.

Keywords

Pancreaticoduodenectomy Pancreaticojejunostomy Pancreatic fistula Perioperative factors Suturing technique 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material (MPG 39054 kb)

References

  1. 1.
    Kleespies A, Albertsmeier M, Obeidat F, Seeliger H, Jauch KW, Bruns CJ. The challenge of pancreatic anastomosis. Langenbecks Arch Surg. 2008;393:459–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery. 2003;134:766–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Poon RT, Lo SH, Fong D, Fan ST, Wong J. Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg. 2002;183:42–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Akamatsu N, Sugawara Y, Komagome M, Shin N, Cho N, Ishida T, et al. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci. 2010;17(3):322–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hosotani R, Doi R, Imamura M. Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy. World J Surg. 2002;26:99–104.PubMedCrossRefGoogle Scholar
  6. 6.
    Tani M, Onishi H, Kinoshita H, Kawai M, Ueno M, Hama T, et al. The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg. 2005;29:76–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Shrikhande SV, Barreto G, Shukla PJ. Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy. Langenbecks Arch Surg. 2008;393:87–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Lane CE, Sawyers JL, Riddle DH, Scott HW Jr. Long-term results of Roux-en-Y hepatocholangiojejunostomy. Ann Surg. 1973;177(6):714–22.PubMedCrossRefGoogle Scholar
  10. 10.
    Azumi Y, Isaji S, Kato H, Nobuoka Y, Kuriyama N, Kishiwada M, et al. A standardized technique for safe pancreaticojejunostomy: pair-watch suturing technique. World J Gastrointest Surg. 2010;27:260–4.CrossRefGoogle Scholar
  11. 11.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complication of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg. 1999;6:303–11.PubMedCrossRefGoogle Scholar
  13. 13.
    van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Overtop H, Gouma DJ. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg. 1997;185:18–24.PubMedGoogle Scholar
  14. 14.
    Abete M, Ronchetti V, Casano A, Pestio G. Pancreatic fistula after pancreaticoduodenectomy: risk factors and treatment. Minerva Chir. 2005;60:99–110.PubMedGoogle Scholar
  15. 15.
    Z’graggen K, Uhl W, Friess H, Büchler MW. How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg. 2002;9:733–7.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011

Authors and Affiliations

  1. 1.Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan

Personalised recommendations