Comparison of the preserving or removing jejunal mucosa pancreatico-jejunal invaginated anastomosis in pancreatoduodenectomy

Abstract

Objective To evaluated the preserving or removing jejunal mucosa pancreatico-jejunal invaginated anastomosis in pancreaticoduodenectomy.Methods Between February 2003 and December 2012,58 patients underwent pancreaticoduodenectomy using pancreaticojejunal invaginated anastomosis in our department.In group A,28 patients received pancreatico-jejunal invaginated anastomosis using jejunum preserving technique.Briefly,3 to 4 cm remanent pancreas was inserted into jejunum and thc jcjunum was bundled up using No.7 silk thread at 2 to 3 cm distant to the cutting surface of the pancreas.In group B,30 patients received pancreatico-jejunal invaginated anastomosis using jejunum removing technique.Briefly,the jejunum mucosa was everted and the proximal 3 cmlong mucosa was removed.Then the everted jejunum was re-positioned and the ending of the jejunum was interruptedly sutured to the remanent pancreas.Finally,the covered jejunum was tied up as the group A.Results The pancrcatico-jejunal anastomosis time was 36 ±0.34 minutes shorter in group A than group B (P ＜0.001).The incidence of pancreatic fistula was higher in group B (20.0％) than group A (0％).In contrast,the incidence of post-operative pancreatic bleeding was compared between the two groups (3.6％ vs 3.3％,P =1.000).Conclusions Preserving ejunum mucosa pancreatico-jejunal invaginated anastomosis was unaffected by pancreatic texture pancreatic duct size and position.This method takes the advantages of simple operation and reducing the incidence of pancreatic fistula. Key words: Pancreaticoduodenectomy; Pancreatico-jejunal invaginated anastomosis; Pancreatic fistula; Postoperative complications ; Hemorrhage