Invagination Pancreaticojejunostomy Research Articles

Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study

Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study

Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized study

BackgroundThe ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated. The aim of the study was to assess the surgical outcomes of duct to mucosa pancreaticojejunostomy (PJ) (G1) and invagination PJ (G2) after PD. MethodsConsecutive patients treated by PD at our center were randomized into either group. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF); secondary outcomes included; operative time, day to resume oral feeding, postoperative morbidity and mortality, exocrine and endocrine pancreatic functions. ResultsOne hundred and seven patients treated by PD were randomized. The median operative time for reconstruction was significantly longer in G1 (34 vs. 30 min, P=0.002). POPF developed in 11/53 patients in G1 and 8/54 patients in G 2, P=0.46 (6 vs. 2 patients had a POPF type B or C, P=0.4). Steatorrhea after one year was 21/50 in G1 and 11/50 in G2, respectively (P=0.04). Serum albumin level after one year was 3.4 gm% in G1 and 3.6 gm in G2 (P=0.03). There was no statistically significant difference regarding the incidence of DM preoperatively and one year postoperatively. ConclusionInvagination PJ is easier to perform than duct to mucosa especially in small pancreatic duct. The soft friable pancreatic tissue can be problematic for invagination PJ due to parenchymal laceration. Invagination PJ was not associated with a lower rate of POPF, but it was associated with decreased severity of POPF and incidence of postoperative steatorrhea. Clinical Trials. gov IDNCT02142517.

End-to-End Invaginated Pancreaticojejunostomy with Three Overlapping U-Sutures––A Safe and Simple Method of Pancreaticoenteric Anastomosis

ABSTRACTBackground: Postoperative pancreatic fistula associated with mortality and morbidity remains an intractable problem after pancreaticoduodenectomy. To date it still carries a notable incidence of roughly 10% to 30% in large series in spite of numerous pharmacological and technical methods that have been proposed to achieve a leakproof pancreatic remnant. Methods: In order to perform a safe anastomosis to pancreatic remnant with less sophisticated sutures and shorter operative duration, a fast and simple technique of end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures was devised in our institution. Results: Between April 2011 and July 2013, end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures technique was used in 23 consecutive cases that underwent pancreaticoduodenectomy in our institute. The median operative time for pancreaticojejunostomy was 12 min. The incidence of pancreatic fistula was 8.7% (n = 2) and both cases were grade A fistula with no clinical impact or delayed hospital discharge. Neither relaparotomy nor postoperative mortality was observed. Conclusions: The technique of using three overlapping U-sutures in an end-to-end invaginated pancreaticojejunostomy represents a simple management of pancreaticoenteric anastomosis with reliability and applicability, and provides an alternative choice for pancreaticojejunostomy to senior pancreatic surgeons as well as those without experience.

Post-pancreaticoduodenectomy hemorrhage risk factors, managements and outcomes

Post-pancreaticoduodenectomy (PD) hemorrhage (PPH) is an uncommon but serious complication. This retrospective study analyzed the risk factors, managements and outcomes of the patients with PPH. A total of 840 patients with PD between 2000 and 2010 were retrospectively analyzed. Among them, 73 patients had PPH: 19 patients had early PPH and 54 had late PPH. The assessment included the preoperative history of disease, pancreatic status and surgical techniques. Other postoperative complications were also evaluated. The incidence of PPH was 8.7% (73/840). There were no independent risk factors for early PPH. Male gender (OR=4.40, P=0.02), diameter of pancreatic duct (OR=0.64, P=0.01), end-to-side invagination pancreaticojejunostomy (OR=5.65, P=0.01), pancreatic fistula (OR=2.33, P=0.04) and intra-abdominal abscess (OR=12.19, P<0.01) were the independent risk factors for late PPH. Four patients with early PPH received conservative treatment and 12 were treated surgically. As for patients with late PPH, the success rate of medical therapy was 27.8% (15/54). Initial endoscopy was operated in 12 patients (22.2%), initial angiography in 19 (35.2%), and relaparotomy in 15 (27.8%). Eventually, PPH resulted in 19 deaths. The main causes of death were multiple organ failure, hemorrhagic shock, sepsis and uncontrolled rebleeding. Careful and ongoing observation of hemorrhagic signs, especially within the first 24 hours after PD or within the course of pancreatic fistula or intra-abdominal abscess, is recommended for patients with PD and a prompt management is necessary. Although endoscopy and angiography are the standard procedures for the management of PPH, surgical approach is still irreplaceable. Aggressive prevention of hemorrhagic shock and re-hemorrhage is the key to treat PPH.

Chen's U-suture technique for end-to-end invaginated pancreaticojejunostomy following pancreaticoduodenectomy.

Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging. This study aims to review a new surgical approach, the Chen's U-stitch technique, for end-to-end invaginated pancreaticojejunostomy, which involves two to four transpancreatic transverse U-sutures, and to evaluate the effectiveness of this approach with reducing the incidence of POPF formation. To evaluate this new approach, during 2002-2012, a total of 264 patients who received the new Chen's U-stitch technique after a PD were included in this study. Postoperative morbidity and mortality, including the incidence of POPF, were analyzed. Postoperative morbidity was 22.3 % (59/264) and mortality was 0 % (0/264). The POPF rate was 3.4 % (9/264) for Grade A, 0.8 % (2/264) for Grade B, and 0 % (0/264) for Grade C. This new surgical technique (Chen's U-stitch), which involves an end-to-end invaginated pancreaticojejunostomy with two to four transpancreatic transverse U-sutures, provides excellent outcomes at reducing the incidence of POPF after PD.

Comparison of duct-to-mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy in terms of development of pancreatic fistula

Comparison of duct-to-mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy in terms of development of pancreatic fistula

Wound Healing after Mesh Inner Embedding and Outer Binding Pancreaticojejunostomy in Piglets

The aim of this study was to introduce a novel technique of pancreaticojejunostomy, namely, mesh inner embedding and outer binding pancreaticojejunostomy, and to evaluate wound healing after this operation in piglets. Thirty-six domestic piglets were randomly divided into 2 groups after pancreaticoduodenectomy: the mesh inner embedding and outer binding pancreaticojejunostomy group (n = 18) and the conventional double-deck invaginated pancreaticojejunostomy group (n = 18). Bursting pressure and breaking strength were assessed on the operative day and on days 7 and 14 postoperatively. The pathologic findings and collagen content of the anastomotic site were evaluated on days 7 and 14 postoperatively. Both the bursting pressure and breaking strength were significantly higher in the mesh inner embedding and outer binding pancreaticojejunostomy group than in the double-deck invaginated pancreaticojejunostomy group on days 0, 7, and 14 (P < .01). The collagen content of the anastomotic site was significantly higher in the mesh inner embedding and outer binding pancreaticojejunostomy group than in the double-deck invaginated pancreaticojejunostomy group on days 7 and 14 postoperatively (P < .01). The anastomotic site was more completely repaired by connective and granulation tissue in the mesh inner embedding and outer binding pancreaticojejunostomy group on day 7 than in the double-deck invaginated pancreaticojejunostomy group. Mesh inner embedding and outer binding pancreaticojejunostomy significantly enhanced the anastomotic firmness and sped up the wound healing process compared with conventional mesh inner embedding and outer binding pancreaticojejunostomy. Therefore, it may decrease the risk of pancreatic fistulas after pancreaticoduodenectomy.

Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis

Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction (duct-to-mucosa versus invagination), by meta-analysis and assessment of evidence quality. Methods Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials (RCTs) comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio (RR) or mean difference. Results From 321 identified abstracts, four RCTs (467 patients; duct-to-mucosa: 232; invagination: 235) were included. Pancreatic fistula rate (RR, 0.74; 95% confidence interval (CI): 0.24-2.28; P=0.60), mortality (RR, 1.18; 95% CI: 0.39-3.54; P=0.77), morbidity (RR, 0.91; 95% CI: 0.69-1.21; P=0.53), reoperation (RR, 1.09; 95% CI: 0.54-2.22; P=0.81) and hospital stay (mean difference, -1.78; 95% CI: -4.60-1.04; P=0.22) were similar between techniques. Conclusions Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.

Effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy

Objective To investigate the effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 396 patients who received pancreaticoduodenectomy at the Cancer Hospital of Shandong Province from January 2001 to January 2011 were retrospectively analyzed. All patients were divided into the improved group （235 patients） and tradi- tional group （161 patients） according to different anastomotic methods. All tile operations were done by the same surgical group, and the digestive tract was reconstructed by the Child method. Patients in the improved group received improved end-to-end invagination pancreaticojejunostomy, and patients in the traditional group received traditional end-to-end anastomosis. The volume of operative bleeding, operation time, incidence of pancreatic fistula and duration of hospital stay of the 2 groups were compared. All data were analyzed using the t test, chi- square test or Fisher exact probability. Results The operative blood loss, operation time and duration of hospital stay were （383 ±56）ml, （7.2 ± 1.0）hours, （21±3）days in the improved group, and （381±39）ml, （7.0 ± 0.5） hours, （22 ± 5 ）days in the traditional group, with no significant difference between the 2 groups （t = 0. 388, 1. 680, - 1. 835, P 〉 0.05 ）. No operative death was detected in the 2 groups, and the overall incidence of pancreatic fistula was 7.6% （30/396）. The incidence of pancreatic fistula of the improved group was 0 （0/235）, which was significantly lower than 18.6% （30/161） of the traditional group （ P 〈 0.05 ）. Patients complicated with pancreatic fistula in the traditional group were cured by drainage, somatostatin administration and parenteral nutrition. Conclusion hnproved end-to-end invagination pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy. Key words: Periampullary neoplasms ; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancre-atic fistula

Dunking pancreaticojejunostomy versus duct‐to‐mucosa anastomosis

Following the resectional aspect of pancreaticoduodenectomy, three anastomoses are used to reestablish gastrointestinal continuity. The pancreatic-enteric anastomosis is by far the most problematic, and has been considered by many the Achilles heel of the pancreaticoduodenal resection. Multiple clinical trials have been published focusing on improving outcomes of the pancreatic-enteric anastomosis, including elements such as the use of prophylactic octreotide, the use of sealants, stenting of the pancreatic duct, and surgical technique. There are two widely used methods to accomplish an end-to-side pancreaticojejunostomy (PJ) after pancreaticoduodenectomy: either invagination PJ or duct-to-mucosa PJ. Two prospective randomized trials have evaluated these techniques, the first a trial by Bassi and co-authors, and the second a trial by Berger et al. In this article we will focus on our current technique for both invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy, recognizing that careful surgical technique, surgeon experience, and surgical volume are factors that are important in yielding the best outcomes.

Opinions on several issues concerning radical pancreaticoduodenectomy for pancreatic head carcinoma

According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience. Key words: Pancreatic head carcinoma; Radical pancreaticoduodenectomy; Hepatoduodenal ligament lyphadenectomy; Ristricted retroperitoneal resection; Uncinate process of pancrease resection

Analysis of Pancreatic Fistula According to the International Study Group on Pancreatic Fistula Classification Scheme for 294 Patients Who Underwent Pancreaticoduodenectomy in a Single Center

The purposes of this study were to validate the value of the International Study Group on Pancreatic Fistula (ISGPF) classification scheme for pancreatic fistula (PF) and to identify predictive factors for clinically significant PF. From January 2000 to December 2007, 294 consecutive patients underwent pancreaticoduodenectomy in a single medical center. Pancreatic fistula was evaluated by the ISGPF criteria and Johns Hopkins Hospital's definition (JHH). Then, logistic regression analysis was performed to identify predictive factors for PF development. Our own management strategies with PF were also discussed. The overall incidence of PF was 19.4% (57/294) according to the ISGPF criteria, and 8.8% (26/294) using the JHH definition. Thirty-one patients with PF classified by the ISGPF were missed by the JHH definition. By logistic regression analysis, we found that besides the lack of cardiovascular disease and malignant diseases, our single-layer continuous circular invaginated pancreaticojejunostomy was another independent factor for the lowered incidence of PF. The ISGPF classification scheme was accurate for evaluating PF. Single-layer continuous circular invaginated pancreaticojejunostomy may be a promising method that may have been responsible for the lower incidence of PF in this study.

Surgical complications after pancreatoduodenectomy: risk factors and treatments

To explore the impact factors and treatment of post pancreatoduodenectomy complications. The clinical data of 412 cases between January 1995 and April 2010 underwent pancreatoduodenectomy were analyzed retrospectively. There were 232 male, 180 female. Univariate and multivariate logistic regression model were used to identify the risk factors related to occurrence of postoperative complications. The overall postoperative morbidity rate was 37.1% (153/412), and mortality rate was 4.6% (19/412). Total uncinate process resection, type of pancreatic-enteric anastomosis, duct diameter and pancreatic texture had effects on postoperative pancreatic fistula statistically. Total uncinate process resection, the amount of intra-operative blood loss ≥ 600 ml and pancreatic fistula were identified as significant risk factors for post pancreatoduodenectomy hemorrhage by means of univariate analysis. Delayed gastric empting occurrence in the patients with pylorus-preserving pancreaticoduodenectomy was higher than those with standard pancreaticoduodenectomy significantly. The multivariate Logistic regression analysis revealed that duct diameter and pancreatic texture were the independent risk factors of pancreatic fistula. Total uncinate process resection, the amount of intra-operative blood loss ≥ 600 ml and pancreatic fistula were independent risk factors of bleeding. There were no statistically significant differences between the radical group and the standard group when postoperative complication rates were analyzed (P < 0.05). Pancreaticojejunal anastomoses by means of duct-to-mucosa is fit for the patients with dilated pancreatic duct and end-to-end invaginated pancreaticojejunostomy is fit for the patients with undilated pancreatic duct. The prevention of postoperative bleeding depends on total uncinate process resection and meticulous hemostatic technique during operation. The pancreatic fistula is one of the most important factors which can result in postoperative bleeding. Pancreaticoduodenectomy combines with SMV/PV resection and extended lymphadenectomy do not significantly increase the morbidity rates.

Clinical effect of three different pancreaticojejunostomy in Whipple

Objective To investigate the clinical results of end-to-end invagination pancreaticojejunostomy.end-to-end invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy of pancreaticoduodencetomy of patients with pancreatic and periampullary carcinoma. Methods Fifty-two patients underwent different pancreaticoduodenectomy in our hospital from August 1995 to July 2006 were collected and analyzed retrospectively.The incidence of pancreatic leakage,operation time,the blood loss and the postoperative complications were analyzed. Results Twenty-five patients received end-to-end invagination pancreaticojejunostomy.Sixteen patients received end-toside invagination pancreaticojejunostomy.Eleven patients received end-to-side pancreaticojejunal mucosa-mucosa anastomosis.The operation time of the duct-to-mucosa pancreaticojejunostomy was shorter than the two of the others(4 ～7.15 h).The perioperative comphcations occurred in 18 cases and the long-term postoperative complications occurred in 10 cases.The average length of stay in hospital was(19.32 ±5.45)days.Two cases died during perioperative period. Conclusion End-to-eed invagination pancreaticojejunostomy,end-to-side invagination pancreaticojejunostomy and end-to-side pancreaticojejunal mucosa-mucosa anastomosis are all common anastomosis methods.Pancreatic leakage is a serious postoperative complication.The selection of anastomosis method is based on the condition during operation. Key words: Pancreatic neoplasms; Pancreaticojejunostomy

Erratum to: A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

Erratum to: A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreato-enteric anastomosis after PD have been proposed to reduce POPF rate. Until now, there is no consensus on which is the best. This study presents a new technique of the end-to-end invaginated pancreaticojejunostomy with two to three transpancreatic U-sutures and evaluates its safety and reliability. From 2002 to 2007, 88 patients (54 men and 34 women) underwent an invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures after PD. The mean age was 52.4 years (range, 26-74 years). The diseases of the all patients were malignant. In all patients of this study, two transpancreatic U-sutures were performed in 59 and three U-sutures in 29. The median duration of surgery was 3.8 h (range 3-6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range 8-25). The median blood loss was 750 ml (range 300-1,800), 36 patients needed transfusion and the median blood transfusion was 380 mL (range 200-1,200). Overall morbidity occurred in 15 patients (17.0%). Only two patients (2.2%) had grade A of POPF and no patient had grade B and grade C of POPF. No operative death occurred. An invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures is simple, rapid, safe, and reliable technique, even in some patients with soft pancreas and small pancreatic duct.

Central pancreatectomy for benign tumors of the neck and body of the pancreas: Report of eight cases

To discuss the advantage of central pancreatectomy in the patients with benign tumors of the neck and body of the pancreas. Eight patients from January 1990 to December 2007 were retrospectively analyzed in our hospital. The operation is carried out by exposition of the pancreatic neck and body involved by the lesion. Thereafter, the lesion is dissected from the spleen artery and porto-mesenteric vein. The cephalic stump is sutured, and the distal stump is anastomosed by an end-to-end invaginated pancreaticojejunostomy with double-layer suture. Central pancreatectomy was done in eight patients including five mucinous cystadenomas, one serious cystadenoma, one insulinoma and one nonfunctional islet cell tumor. No mortality rate developed and morbidity rate was 37.5%. Pancreatic fistula occurred in three cases and was treated conservatively. Central pancreatectomy is a safe technique for benign tumors of the pancreatic neck and body, especially when the enucleation is very difficult.

Conservative resection for benign tumors of the proximal pancreas

To evaluate the safety and long-term prognosis of conservative resection (CR) for benign or borderline tumor of the proximal pancreas. We retrospectively analyzed 20 patients who underwent CR at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2000 and October 2008. For pancreaticojejunostomy, a modified invagination method, continuous circular invaginated pancreaticojejunostomy (CCI-PJ) was used. Modified continuous closed lavage (MCCL) was performed for patients with pancreatic fistula. The indications were: serous cystadenomas in eight patients, insulinomas in six, non-functional islet cell tumors in three and solid pseudopapillary tumors in three. Perioperative mortality was zero and morbidity was 25%. Overall, pancreatic fistula was present in 25% of patients. At a mean follow up of 42.7 mo, all patients were alive with no recurrence and no new-onset diabetes mellitus or exocrine dysfunction. CR is a safe and effective procedure for patients with benign tumors in the proximal pancreas, with careful CCI-PJ and postoperative MCCL.

The Dagradi-Serio-Iacono Operation Central Pancreatectomy

Central pancreatectomy (CP) is a segmental pancreatic resection indicated to remove benign or low-grade malignant tumors of the isthmus and proximal part of the body of the pancreas. The main advantage of this operation compared with major resections is that it permits to spare normal pancreatic parenchyma; moreover, spleen and upper digestive and biliary tracts are saved. The description of the complete operation was reported for the first time by Dagradi and Serio in 1984 and subsequently spread worldwide by Iacono and Serio. In our opinion, it should be called the Dagradi–Serio–Iacono operation, by the names of the surgeons who first performed it (Dagradi and Serio), and by the names of the surgeons responsible for reporting it worldwide with precise indications (Iacono and Serio). Operation requires a midline or a bilateral subcostal incision; the lesser sac is entered through dissection of the transverse colon from the omentum or by transecting the gastrocolic ligament. The pancreatic segment harboring the lesion is then mobilized and its posterior surface carefully dissected from the splenic vein and artery. Subsequently, the pancreatic portion harboring the tumor is isolated at its superior margin from the splenic artery after the pancreas is transacted. The extent of the resection of the central segment is limited on the right by the gastroduodenal artery and on the left by the need to leave at least 5 cm of normal pancreatic remnant. The resected pancreatic specimen is sent to the pathologist for confirmation of diagnosis and to check if the resection margins are adequate. Hemostasis of the two raw surfaces is achieved with interrupted 5 or 4/0 nonabsorbable stitches. When it is not stapled, the Wirsung’s duct of the cephalic stump is sutured selectively with a figure-of-eight nonabsorbable stitch. An end-to-end invaginated pancreaticojejunostomy is carried out with a single layer of interrupted stitches. The operation is concluded with the construction of an end-to-side jejuno-jejunostomy about 50 cm distal to the pancreatic anastomosis. Other techniques for reconstruction of the distal stump using jejunum or stomach have been described. One or two soft drains are brought out on the right side. The fluid collected from this drain is checked for amylase level on postoperative days 3, 5, and 7; if the level is low or absent, the drain is removed. Central pancreatectomy is a safe technique for benign or low malignant tumors of the pancreatic neck that allows curing the tumor with evident functional results without increasing the risk for the patient. We can say that CP has a clear role like pancreaticoduodenectomy and distal pancreatectomy and we think that a pancreatic surgeon has to include this procedure in his/her technical skills. In order to obtain excellent results, correct indications and experience in pancreatic surgery are recommended.

Effect of end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture in pancreatic surgery

The aim of this paper is to summarize the methods of pancreaticojejunostomy in the pancreatic operation and to study the safety and feasibility of a new operative method called end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture to prevent fistula of pancreaticojejunostomy. Eight-three patients with pancreaticoduodenectomy in the 3rd Hospital, Jilin University from 2001 January to 2006 April were reviewed. The incidences of pancreatic fistula with different types of pancreaticojejunostomy were compared. The overall incidence rate of pancreatic fistula was 26.5% (22/83). No pancreatic fistula occurred in end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture. The incidence rate of the fistula following end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture was significantly lower than that of traditional end-to-end pancreaticojejunostomy [40%, (10/25), P<0.01] and end-to-side pancreaticojejunostomy [27.3%, (12/44), P<0.05], but no significant difference (P>0.05) between traditional end-to-end pancreaticojejunostomy and end-to-side pancreaticojejunostomy was discovered. End-to-end invagination pancreaticojejunostomy with circle discontinuous U suture has a definite effect on avoiding pancreatic fistula following pancreaticojejunostomy and is worth being recommended. But the cases were limited, so this method would still need to be observed and confirmed further in the future.