Experimental study of pancreaticojejunostomy completed using anastomotic chains

Abstract

The most difficult, time-consuming, and complication-prone step in pancreaticoduodenectomy is the pancreaticojejunostomy step. The largest disadvantage of this kind of anastomosis is the high incidence of postoperative anastomotic leakage. Once pancreatic leakage occurs, the patient death rate can be very high. The aim of this study was to design a pancreaticojejunostomy procedure using anastomotic chains, which results in the cut end of the jejunum being attached to the pancreatic stump without suturing, and to evaluate the safety and efficacy of this procedure in domestic pigs. The pancreaticojejunal anastomotic chains had the following structures: the chains consisted of two braceletlike chains made of titanium, named chain A and chain B. The function of chain A was to attach the free jejunal end onto the pancreatic stump, whereas the function of chain B was to tighten the contact between the jejunal wall and the surface of the pancreatic stump to eliminate gaps between the two structures and ensure tightness that is sufficient to guarantee that there is no leakage of jejunal fluid or pancreatic juice. The following procedure was used to assess the safety and efficacy of the procedure: pancreaticojejunostomies were performed on ten domestic pigs using anastomotic chains. The time required to complete the pancreaticojejunal anastomoses, the pressure tolerance of the pancreaticojejunal anastomoses, the pig death rate, and the histopathological examinations of the pancreaticojejunostomy tissues were recorded. The average time required to complete the pancreaticojejunal anastomosis procedure was 13+/-2 min. The observed tolerance pressure of the pancreaticojejunal anastomoses was more than 90 mm H(2)O. All ten domestic pigs that underwent operations were still alive four weeks after the operations. Pathological examinations showed that the anastomotic surfaces were completely healed, and the pancreatic cutting surfaces were primarily epithelialized. In conclusion, the use of anastomotic chains in pancreaticojejunostomy procedures results in a decrease in or elimination of pancreatic leakage. In addition, the procedure is simple to perform, is not time-intensive, and appears to be safe in a pig model.