PANCREATICOJEJUNOSTOMY AND HEPATICO-JEJUNOSTOMY WITHOUT STENT TUBE IN THE PANCREATODUODENECTOMY

Abstract

Background: There is a risk of anastomotic leakage after pancreaticojejunostomy and hepaticojejunostomy after pancreatoduodenectomy. Therefore, pancreaticojejunostomy or hepaticojejunostomy is generally performed using a stenting tube (stented method). However, pancreaticojejunostomy and hepaticojejunostomy with a certain duct-to-mucosa anastomosis do not always require a stenting tube. Objective: The aim of this study is to show our techniques for pancreaticojejunostomy and hepaticojejunostomy and to evaluate the operative results after pancreatoduodenectomy. Operative techniques: The point of this technique is to maintain adequate patency of the anastomosis using a fine atraumatic needle and monofilament thread. The end-to-side anastomosis between the pancreas and jejunum consists of double layer sutures. Interrupted sutures are placed in the inner layer using 6-0 or 5-0 absorbable sutures. The end-to-side anastomosis between the hepatic duct and jejunum consists of single layer sutures. Interrupted sutures are placed using 6-0 or 5-0 absorbable sutures. The important aim of this technique is to preserve adequate patency of the anastomosis without any stenting tube. Methods: Among 596 patients who underwent pancreatoduodenectomy between January 1995 and December 2005, 285 patients underwent pancreaticojejunostomy and hepaticojejunostomy using these techniques. Results: Mortality was 0.3%(1). Leakage of the pancreaticojejunostomy occurred in 9 of 285 patients (3.1%), and leakage of the hepaticojejunostomy occurred in 5 of 285 patients (1.7%). Conclusion: A certain duct-to-mucosa anastomosis without stenting tube is a simple, fine and safe procedure for pancreaticojejunostomy and hepaticojejunostomy in the pancreatoduodenectomy.