The application of purse string suture and the end-to-side invagination pancreaticojejunostomy in pancreaticoduodenectomy

Abstract

Objective To investigate the application of purse string suture and the end-to-side invagination pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods Clinical data of 175 cases who were admitted in Cangzhou Central Hospital and underwent pancreaticoduodenectomy because of malignant tumor from December 2012 to December 2016 were retrospectively analyzed. According to the texture of pancreas in the operation, the patients were divided into 2 groups. Purse string suture and the end-to-side invagination pancreaticojejunostomy was performed in study group. Duct-to-mucosa pancreaticojejunostomy was conducted in control group. The operation time, the time of pancreaticojejunostomy, the amount of intraoperative bleeding, the incidence of postoperative pancreatic fistula, postoperative recovery time of gastrointestinal function, the average length of hospital stay and the like were comparative analyzed between the two groups. Results There was no significant difference on gender, age, primary diagnosis, preoperative total serum bilirubin, alanine aminotransferase and serum albumin levels between the two groups. The pancreatic texture of the study group was softer than that of the control group, the pancreatic duct diameter in the study group was significantly smaller than that in the control group [(2.0±0.9)mm vs (3.4±1.3)mm], the time of pancreaticojejunostomy in the study group was significantly shorter than that in the control group [(13±4)min vs (17±7)min], the incidence of postoperative pancreatic fistula in the study group was significantly lower than that in the control group(5.88% vs 15.56%), and the differences were statistically significant (all P<0.05). There was no significant difference on mean operative time, mean blood loss, postoperative gastrointestinal recovery time and average hospital stay between the two groups. 1 cases with postoperative abdominal bleeding occurred in the study group, and the bleeding was successfully stopped by secondary surgery. Conclusions Purse string suture and the end-to-side invagination pancreaticojejunostomy was simple, safe and effective, which had a advantage of reducing the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula. Key words: Pancreaticojejunostomy; Pancreaticoduodenectomy; Pancreatic fistula