Chen’s continuous suture technique for invaginated pancreaticojejunostomy following pancreaticoduodenectomy with no grade B/C POPF and zero motality in 644 patients with soft pancrease and small pancreatic duct

Abstract

Introduction: Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the POPF incidence, a number of technical modifications for pancreato-enteric anastomosis after PD has been proposed. In 1995, we established a new suture technique for end-to-end or end-to-side invaginated pancreaticojejunostomy (PJ) following PD, and the preliminary results were quite encouraging. This study aims to review this new surgical approach, the Chen’s continuous suture technique for invaginated PJ, to evaluate the effectiveness of this approach in reducing the incidence of POPF. Method: To evaluate this new approach, 1852 patients from 8 medical center in China receiving the Chen’s continuous suture technique after a open PD from Jan. 2016 to Jan. 2019 were reviewed. Among them, 644 (34.8%) patients were with soft pancrease and small duct (small than 3 mm in diameter) and were included in this study. The postoperative morbidity and mortality including the POPE incidence were analyzed. Result: The postoperative morbidity was 27% (174/644) and mortality was 0% (0/644). The POPF rate was 8.8% (57/644) for Grade A, and no Grade B and Grade C POPF occurred. Conclusion: Chen’s continuous suture technique is a simple method and provides excellent outcomes in lowering POPF incidence following PD in the patients with the soft pancrease and a small pancreatic duct.