Telescopic Invagination Transpancreatic End-to-end Pancreatojejunostomy

Abstract

Background: Postoperative pancreatic fistula is the main cause of operative morbidity andmortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative fistula rate. No consensus exists regarding the most effective form of pancreaticojejunostomy. In this presentation the telescopic invagination transpancreatic end-to-end pancreatojejunostomy is described. Method: Especially in soft pancreas we are using the telescopic invagination method. We are using two double-armed PDS mattress sutures going through two layers of jejunum making an intestinal cuff, after that through the pancreas, another two layers of jejunum and the same on the way back. After suturing the invagination is created. Another two PDS sutures on the edges of anastomosis are usually sufficient. Results: There were 81 pancreatoduodectomies in 3 years provided in our surgery, 10 of these were operated with described telescopic method (one surgeon). In this group the rate of pancreatic fistula is 10%, in other group (different methods and surgeons) the pancreatic fistula rate is 21%. Conclusion: Telescopic invagination transpancreatic end-to-end pancreatojejunostomy seems to be good technique. Further studies with more patients are needed.