Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy
- 597 Downloads
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.
KeywordsPancreatic Duct Pancreatic Fistula Jejunum Loop Pancreatic Stump Postoperative Pancreatic Fistula
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 1 (MPG 44582 kb)
Single-needle U-suture technique (cartoon) (WMV 15988 kb)
Two-needle U-suture technique (cartoon) (AVI 11483 kb)
Two-needle U-suture technique (operative demonstration) (WMV 189946 kb)
- 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
- 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