The effect of bilateral U-sutures in pancreaticojejunostomy in 75 consecutive cases

Abstract

Background: Various technical interventions have been suggested to decrease the frequency of postoperative pancreatic fistulas but the effect is not particularly satisfactory. We have analyzed our application of bilateral U-sutures in pancreaticojejunostomy.Methods: The pancreatic stump is freed over approximately 2 cm, an appropriate diameter silicone catheter with 2–4 lateral holes was inserted into the remnant pancreatic duct (>2 mm in diameter is required) over 2–3 cm as a stent in 69 patients. In six patients with soft pancreas and very small pancreatic duct (<2 mm in diameter), the silicone catheter was not used. An incision was made on the side of the distal section of the jejunum and end-to-side an invaginated pancreaticojejunostomy was performed using bilateral U-sutures.Results: Only two (2.67%) cases developed pancreatic ‘biochemical leaks’. None of the 75 patients developed grade B and grade C pancreatic leakage. The overall morbidity was 29.33%. The anastomosis time was 14 minutes on average. There were no symptoms such as abdominal discomfort, dyspepsia and diarrhea, and no dilatation of pancreatic duct was found by CT in 75 patients after discharge from hospital.Conclusions: Bilateral U-sutures are a safe, simple, and effective technique in pancreaticojejunostomy, preventing the primary complication of anastomotic leakage, and worthy of wide use.