Clinical application of monolayer continuous suture in the end-to-side invaginated pancreaticojejunostomy during pancreatoduodenectomy

Abstract

Objective To investigate the effect of monolayer continuous suture in end-to-side invaginated pancreaticojejunostomy for preventing postoperative pancreatic fistula during pancreatoduodenectomy. Methods All clinical data of 32 patients in the First Affiliated Hospital of Zhengzhou University from January 2008 to December 2011, including 19 males and 13 females with an average age of 58 years were collected for retrospective analysis. All patients underwent pancreatoduodenectomy. The main pancreatic duct was found after pancreas resection, and was anastomosed with jejunum by end-to-side invaginated pancreaticojejunostomy using monolayer continuous suture with 4-0 prolene stitch thread. This study was approved by local ethical committee and the informed consent of all participating subjects was obtained. The operating time of pancreaticojejunostomy and postoperative complications including pancreatic fistula and biliary fistula were observed. Results All the 32 patients underwent monolayer continuous pancreaticojejunostomy successfully with the average time of 12 minutes (8-18 minutes). No pancreatic nubs and intestinal loop bleeding occurred in all patients. There was neither postoperative pancreatic fistula nor death case. One patient developed biliary fistula and recovered by conservative treatment. The average length of postoperative hospital stay was 15 days. Conclusions The monolayer continuous suture in the end-to-side invaginated pancreaticojejunostomy during pancreatoduodenectomy is effective in reducing the morbility of pancreatic fistula. It is an improvement of pancreatoduodenectomy. Key words: Pancreatoduodenectomy; Pancreaticojejunostomy; Mondayer continuous suture; Complication; Pancreatic fistula