Abstract
Background: Pancreatoduodenectomy (PD) is a complex procedure with a relatively high risk of complications. There is an increasing trend showing that the success of pancreato-enteral anastomosis depends on surgical skill and the material used. Methods: We present four cases of pancreato-enteral anastomosis resected 37 - 114 days after primary surgery and the analysis of the healing process, i.e., morphology of the pancreatic parenchyma, pancreatic duct, and digestive tract mucosa, as well as the pancreatic reaction to the sewing material by microscopic morphometry. Results: Evidence of regeneration in the columnar-lined mucosa of main pancreatic ducts in all cases of pancreato-enterostomy was observed. The inflammatory foreign-body reaction around monofilament stitch was present without an evident infection. There were no microscopic signs of pancreatic duct damage. Total foreign body reaction varied between 138.1 μm and 207.3 μm. Conclusions: This observation supports the beneficial use of thin monofilament threads for pancreato-enteral anastomosis. There was no evidence of harmful action from gastric or intestinal juices on pancreatic remnant or the Wirsung duct.
Highlights
Pancreatoduodenectomy (PD) was first performed by Kausch one hundred years ago and perfected by Whipple seventy-five years ago
The most controversial, variable and widely-discussed part of this procedure is the management of the pancreatic remnant, especially since the partner for pancreatic anastomosis could be the small bowel or the stomach [2]
We evaluated the early morphological changes in four patients requiring re-resection after pancreatico-gastro or pancreatico-enteral anastomosis
Summary
Pancreatoduodenectomy (PD) was first performed by Kausch one hundred years ago and perfected by Whipple seventy-five years ago. Some factors can be predictors of pancreatic fistula development, i.e., a small pancreatic duct or a soft pancreatic texture [3,4]. The cause of this might be the fragile tissue parenchyma prone to microinjury during reconstruction. Several investigations of pancreato-enteral anastomosis have been performed to assess factors detrimental to pancreatic anastomosis healing. Methods: We present four cases of pancreato-enteral anastomosis resected 37 - 114 days after primary surgery and the analysis of the healing process, i.e., morphology of the pancreatic parenchyma, pancreatic duct, and digestive tract mucosa, as well as the pancreatic reaction to the sewing material by microscopic morphometry. There was no evidence of harmful action from gastric or intestinal juices on pancreatic remnant or the Wirsung duct
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