Efficacy analysis of double- "U" embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic leakage

Abstract

Objective To investigate the efficacy of double- U embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula. Methods The retrospective cohort study was adopted. The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People′s Hospital from March 2011 to March 2015 were collected. Of 208 patients, 106 patients undergoing double- U embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double- U group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group. Observation indicators included (1) surgical effects: anastomosis time, postoperative pancreatic leakage, duration of hospital stay, (2) follow-up situations. The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed by t test. Count data were analyzed using the chi-square test. Results (1) Surgical effects: 208 patients underwent successful surgery without occurrence of death. The anastomosis time was (13.0±1.5)minutes in the double- U group and (20.0±1.6)minutes in the Child group, with a statistically significant difference between the 2 groups (t=4.713, P<0.05). Two patients in the double- U group were complicated with grade A of pancreatic leakage, including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant. Nine patients in the Child group were complicated with pancreatic leakage, including 6 in grade A, 1 in grade B and 2 in grade C, and there were 6 of 33 patients (4 in grade A, 1 in grade B, 1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A, 1 in grade C) with fibrotic pancreatic remnant. There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (χ2=2.951, 4.994, P<0.05). The duration of postoperative hospital stay was (13.5±1.2)days in the double- U group and (15.7±2.6)days in the Child group, with a statistically significant difference (t=1.011, P<0.05). No readmission in the 2 groups occurred. (2) Follow-up situations: 91 of 106 patients in the double- U group were followed up for 6-54 months with a median time of 30 months. During the follow-up, 8 patients were dead, 12 patients didn′t undergo reoperation due to multiple metastases in the liver, lung and greater omentum, 4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis, and other patients had good conditions without the occurrence of diabetes, diarrhea, indigestion and hypopancreatism. Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months. During the follow-up, 10 patients were dead, 11 patients didn′t undergo reoperation due to multiple metastases in the liver, lung and greater omentum, 6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis, and other patients had good conditions without the occurrence of diabetes, diarrhea, indigestion and hypopancreatism. Conclusion Double- U embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time, incidence of pancreatic leakage and duration of postoperative hospital stay, and it is especially suitable for the patients with normal pancreatic remnant. Key words: Pancreatic diseases; Duodenal papillary neoplasms; Bile duct neoplasms; Double- U embedding and pursestring suture and binding pancreaticojejunostomy; Pancreaticojejunostomy; Pancreatic leakage