New pancreaticojejunostomy preventing from pancreatic leakage by punctured stent slide guiding method to the mechanisms of pancreatic leakage

Abstract

The most cause of pancreatic leakage might be a technical failure because of the anastomosis technique, the difference of anastomosis between pancreatic duct and caliber of jejunum, and the threads. In this study, we devised the new anastomotic method of pancreato-jejunostomy, so called ‘ Punctured Stent Sliding Guide` method using a pancreatic duct stent. We demonstrated its method and results. The pancreatic duct stent, which is fit for a diameter of pancreatic duct, is used for the direct puncture without any incineration. The aims of direct puncture are both the avoidance of the enlargement of anastomotic opening and disturbance of blood flow. The contralateral of anastomotic opening is also punctured and the stent is pulled out of the jejunum. The 6-0 PDS with the needles at both ends is used for anastomotic thread. Firstly, the eversion anastomosis of posterior wall is done by sliding the needle on the stent. And then the anastomosis of anterior wall is done by the same way. Afterthat, modified Kakita method is done. The stent of contralateral side is cut and the hole is closed. The 14 cased of pancreato-jejunostomy by PSSG method were done. The disease of patients were pancreatic cancer (n=5), bile duct cancer (n=5), and Papilla vater cancer (n=1). The pancreatic leakage by the ISGPF were Grade 0:13, A:1, B:0, C:0 respectively. The total incidences of PL among the first period (2004–2013), the second period (2014∼), the third period (PSSG mehod only) were 38%, 16.6%, 7.1%. The our new device of PSSG method for pancreato-jejunostomy might be very effective.