Abstract
Background: Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy (PD). The most significant riskfactors for pancreatic leakage are pancreatic texture, main pancreatic duct (MPD) size and anastomotic technique. Herewith we describe our technical modifications for single-layer pancreaticojejunostomy (PJ) with a soft pancreas and nondilated MPD for reconstruction after PD. Methods: We report our early experience using this technique in 52 patients who underwent PD between May 2009 and December 2012. Results: Overall postoperative mortality rate was1.92%. Postoperative morbidity rate was 32.69%, with major complications occurring in three patients (5.77%). Pancreatic leak was diagnosed in sixpatients (11.54%). Three patients with pancreatic fistulae (PF) of Grades A and B were managed conservatively, whereas three other patients with PF of Grade C required relaparotomy. Conclusions: According to our early experience with this modified technique for PJ, usage of horizontal mattress sutures, “everting” of MPD and incorporation of its wall into a single layer pancreatic-enteric anastomosis result in a low pancreatic anastomotic leakagerate after PD. This technique for PJ with a soft pancreas and nondilated ductensures ideal preconditions for anastomosis healing. They consist of an excellent blood supply, an anatomical position with tension-free approximation and unobstructed pancreatic juice flow from the pancreas into the jejunal loop.
Highlights
Pancreaticoduodenectomy (PD) remains the procedure of choice for treatment of periampullary and pancreatic head cancer
PJ is the preferred method for anastomosis, pancreatic fistulae (PF) incidence does not seem different according to the many techniques proposed for pancreatic digestive continuity reconstruction [8]
PFs were identified by the presence of amylase-rich fluid of more than three times than the serum concentration collected from postoperative day 3 from the drain placed intraoperatively in the abdomen, in accordance with criteria defined by the International Study Group on Pancreatic Fistula (ISGPF) [14]
Summary
Pancreaticoduodenectomy (PD) remains the procedure of choice for treatment of periampullary and pancreatic head cancer. Kakinoki et al apply a triple secured technique with ultrasonic dissector for pancreatic transection with skeletonizing and ligating the small pancreatic branch ducts, duct-invagination or duct-to-mucosa anastomosis for MPD management and four large stitches between the pancreatic stump parenchyma and the jejunal seromuscular layer to prevent minor pancreatic leakage in 28 consecutive patients with soft pancreas after PD [13]. Conclusions: According to our early experience with this modified technique for PJ, usage of horizontal mattress sutures, “everting” of MPD and incorporation of its wall into a single layer pancreatic-enteric anastomosis result in a low pancreatic anastomotic leakage rate after PD. This technique for PJ with a soft pancreas and nondilated duct ensures ideal preconditions for anastomosis healing. They consist of an excellent blood supply, an anatomical position with tension-free approximation and unobstructed pancreatic juice flow from the pancreas into the jejunal loop
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