Pancreaticojejunostomy In Pancreaticoduodenectomy Research Articles

A modified single-needle continuous suture of duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy.

The pancreatic reconstruction technique decides the incidence of postoperative pancreatic fistulas (POPF) in pancreaticoduodenectomy (PD). This study aims to evaluate the safety of modified single-needle continuous suture (SNCS) of duct-to-mucosa and compare the efficacy with double-layer continuous suture (DLCS) of duct-mucosa pancreaticojejunostomy (PJ) in open PD (OPD). A total of 266 patients that received PD between January 2019 and May 2023 were retrospectively analyzed. Among them, 130 patients underwent DLCS, and 136 patients underwent SNCS [73 OPD and 63 laparoscopic PD (LPD)]. The primary outcome was clinically relevant POPF (CR-POPF) according to the definition of the revised 2016 International Study Group of Pancreatic Fistula (ISGPF). Propensity score matching (PSM) was conducted to reduce confounding bias. A total of 66 pairs were successfully matched using PSM in OPD. No significant difference was observed in the occurrence of CR-POPF between the two groups (9.1% vs. 21.2%, P=0.052). However, the median duration of operation and PJ was shorter in the SNCS group. The incidence of CR-POPF in LPD was 9.5%. Furthermore, regarding the alternative fistula risk score (a-FRS), the CR-POPF rate were 2.1%, 10.5%, and 15.6% in low-, intermediate-, and high-risk groups (P=0.067). The SNCS is a facile, safe, and effective PJ technique and does not increase the incidence of POPF, regardless of a-FRS stratification, pancreatic texture, and main pancreatic duct (MPD) size.

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

BackgroundTo explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD).MethodsThe clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression.ResultsThe incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05).ConclusionsWrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.

Comparison of longterm exocrine and endocrine function following duct to mucosa versus dunking pancreaticojejunostomy in pancreaticoduodenectomy

Aim: Though survival following Pancreaticoduodenectomy (PD) has improved, long term impairment of exocrine and endocrine function remains problematic. This study aims at evaluating any difference in long term pancreatic function between those who underwent Duct to Mucosa Vs. Dunking PJ (pancreaticojejunostomy) following PD. Methodology: Patients who underwent PD between the year 2010-18 and were disease free on follow up were evaluated. Patients with chronic pancreatitis were excluded. All survivors beyond 18 months were evaluated for their pancreatic exocrine (Fecal Elastase-1) and endocrine (FBS/PPBS; HbA1c) function as per the Departmental protocol. The risk of developing nutritional impairment was assessed using the Mini Nutritional Assessment (MNA®) tool and by Serum albumin and Hemoglobin. Results: 136 patients satisfied the inclusion criteria. 30 day mortality was 5, 26 had expired and 53 were lost to follow up. Of the remaining 52 who were evaluated, 32 had dunking PJ, 20 had duct to mucosa PJ. Exocrine insufficiency was present in 29/32(90.6%) of dunking PJ and 17/20(85%) of duct to mucosa PJ (P = 0.24). 11(34.4%) & 4 (20%) had endocrine insufficiency in dunking and duct to mucosa groups respectively (P=0.21). Endocrine insufficiency was significantly higher in adjuvant chemoradiotherapy group (P=0.04). The relative risk of developing nutritional impairment in presence of severe pancreatic exocrine insufficiency was 2.68. Conclusion: Exocrine and Endocrine dysfunction post PD can occur irrespective of the type of pancreatic anastomosis and is comparable between the two groups. There appears to be a significant risk of nutritional impairment post PD.

Clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy

Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods The retrospective cohort study was conducted. The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected. There were 26 males and 13 females, aged (60±7)years, with a range of 41-75 years. All the 39 patients underwent PD, using Child method to reconstruct digestive tract. Of 39 patients, 19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group, respectively. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) follow-up. Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence, main pancreatic duct dilatation, survival, and discomfort (abdominal pain, bloating, indigestion, etc.) of patients up to October 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed by t test. Measurement data with skewed distribution were represented as M (P25, P75) or M (range), and comparison between groups was analyzed by Mann Whitney U test. Count data were expressed as absolute numbers, and comparison between groups was analyzed by chi-square test or Fisher exact probability. Results (1) Surgical situations: operation time, volume of intraoperative blood loss, cases with soft pancreas or hard pancreas (pancreatic texture), pancreatic duct diameter, time of pancreatic duct removal, cases using somatostatin, and duration of postoperative hospital stay of the innovative group were (342±47)minutes, 400 mL (300 mL, 400 mL), 10, 9, 3.1 cm (2.9 cm, 3.4 cm), 37 days (32 days, 63 days), 17, 18 days (15 days, 22 days), respectively, versus (392±95)minutes, 400 mL (300 mL, 525 mL), 6, 14, 3.6 cm (2.6 cm, 4.2 cm), 43 days (34 days, 49 days), 18, and 24 days (15 days, 27days) of the traditional group; there was no significant difference in the volume of intraoperative blood loss, cases with soft pancreas or hard pancreas (pancreatic texture), pancreatic duct diameter, time of pancreatic duct removal, cases using somatostatin, and duration of postoperative hospital stay between the two groups (Z=-0.775, χ2=2.063, Z=-1.155, Z=-0.295, χ2=0.003, Z=-1.286, P>0.05); but a significant difference in operation time between the two groups (t=-2.114, P 0.05), but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P<0.05). Patients with postoperative complications were improved after symptomatic support treatment, and no patient died during the perioperative period. (3) Follow-up: of the 39 patients, 33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months, with a median follow-up time of 17 months. Of the 18 patients receiving follow-up in the innovative group, 5 died of tumor recurrence and metastasis, with a survival time of 5-24 months, 1 had tumor recurrence at 34 months after operation, 1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension, 5 had indigestion, 1 had back pain, and 5 had good recovery. Of 15 patients receiving follow-up in the traditional group, 10 died of tumor recurrence and metastasis, with a survival time of 3-57 months, 2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension, 2 had indigestion, 1 had good recovery. Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy, modified invagination for pancreaticojejunostomy in the PD is safe and feasible, which can simplify the operation, reduce the requirements for the operator′s operation skills, shorten the operation time, and reduce incidence of postoperative grade B and C pancreatic leakage. Key words: Pancreatic neoplasms; Duodenal neoplasms; Common bile duct tumors; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreatic leakage; Surgical techniques

Selection of pancreaticojejunostomy in pancreaticoduodenectomy

The proper selection of pancreaticojejunostomy in pancreaticoduodenectomy is very important factor for patients' postoperative recovery. The method of pancreaticojejunostomy should be performed individually on the basis of the pancreatic texture, size of pancreatic residue, duct size, duct location, jejunal size, et al. The paper presents a review of widely used pancreaticojejunostomy and our experience. Key words: Pancreatoduodenectomy (PD); Pancreaticojejunostomy; Duct-to-mucosa anastomos

AB129. P105. A comparative study of the totally one-layer and stratified pancreaticojejunostomy in pancreaticoduodenectomy

Background: Pancreatoduodenectomy (PD) is used to treat diseases of the pancreatic head, the duodenum and ampullar region. The most common disease treated includes cancer, traumatic lesions and chronic pancreatitis. Pancreatojejunostomy (PJ) is surgical procedure commonly used to reconstruct the pancreatic stump after pancreatoduodenectomy, which means the pancreatic stump must be connected with the small bowel where pancreatic juice can play its role in food digestion. There are dozens of different ways about Pancreatojejunostomy. All of these procedures have a non-negligible rate of postoperative complications. Since it is unclear which procedure is better, there are currently no international guidelines on how to reconstruct the pancreatic stump after pancreatoduodenectomy, and the choice is based on the surgeon’s personal preference. The aim of this study was to compare the safety and efficacy of a new technology, totally one-layer pancreaticojejunostomy, with conventional stratified pancreaticojejunostomy after pancreaticoduodenectomy in preventing post-operative pancreatic fistula (POPF).

Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy

Postoperative pancreatic fistula (POPF) is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy (PD). This was a prospective randomized clinical trial comparing the outcomes of PD between patients who underwent total closure of pancreatic section for end-to-side pancreaticojejunostomy (Group A) vs those who underwent conventional pancreaticojejunostomy (Group B). The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B (4.8% vs 16.7%, P<0.05). About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A (P<0.01). The wound/abdominal infection rate was also much higher in Group B than that in Group A (20.0% vs 6.3%, P<0.05). Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively (P<0.001). However, there was no difference in the probability of mortality, biliary leakage, delayed gastric emptying, and pulmonary infection between the two groups. Total closure of pancreatic section for end-to-side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.

Sealing with Cyanoacrylate and a Falciform Patch Cannot Prevent Postoperative Pancreatic Fistula

This study aimed to evaluate the effect of a new combined method of covering the pancreatic anastomosis or stump with a cyanoacrylate and a falciform patch (CAFP) on the occurrence of postoperative pancreatic fistula (POPF). Patients undergoing a pancreaticoduodenectomy (PD) or a distal pancreatectomy (DP) were recruited over a period of 12months. The pancreaticojejunostomy in PD and the stump in DP were sealed with cyanoacrylate glue and wrapped in a falciform patch. Incidence and severity of POPF and associated postoperative complications were retrospectively compared with historical controls of 750 PD and 336 DP at the same institution and with current data from the literature. The new method was applied in 27 PD and 25 DP. The rate of clinically relevant POPF after PD with CAFP was 22.2% compared to 14.4% in historical patients, p=0.26. The rate of clinically relevant POPF after DP with CAFP was 36% compared to 30% in historical patients, p=0.65. Sealing the pancreatic anastomosis or stump with a combination of a cyanoacrylate glue and a falciform patch didn't reduce the rate of POPF after major pancreatic resections.

Safety of Non-stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

It has been reported that pancreatic duct stenting for pancreaticojejunostomy in pancreaticoduodenectomy prevents postoperative pancreatic fistula. However, some reports describe severe complications associated with pancreatic duct stenting; it is controversial whether pancreatic duct stent should be used for pancreaticojejunal anastomosis in pancreaticoduodenectomy. The aim of this study was to compare the incidence of pancreatic fistula between non-stented, externally stented, and internally stented pancreaticojejunostomy in pancreaticoduodenectomy for patients with soft pancreas. Ninety-eight patients undergoing pancreaticoduodenectomy with soft pancreas were divided into three groups: a non-stented group (n=14), an externally-stented group (n=56), and an internally-stented group (n=28), then clinical outcomes were compared. The frequency of clinically relevant postoperative pancreatic fistula (grade B or C) was 14% in the non-stented group, 36% in the externally-stented group, and 39% in the internally-stented group, respectively (p=0.19). The morbidity and mortality rates were also comparable between the three groups (p=0.17 and p=0.88, respectively). Since pancreatic duct stenting in pancreaticojejunal anastomosis for patients with soft pancreas did not reduce pancreatic fistula after pancreaticoduodenectomy, non-stented pancreaticojejunostomy for soft pancreas seems safe.

The Evaluation of Internal Stent-Related Complications and Risk Factors of Stent Migration in Pancreaticoduodenectomy

The placement of an internal stent through a pancreatic anastomosis is one of the surgical techniques to reduce the incidence of pancreatic fistula. However, the fate of the internal stent after placement remains unclear. The aim of this study was to evaluate stent-related complications and risk factors of stent migration through pancreaticojejunostomy in pancreaticoduodenectomy. We retrospectively analyzed 159 patients who underwent pancreaticoduodenectomy or subtotal stomach-preserving pancreaticoduodenectomy. Stent migration and stent defecation were confirmed by computed tomography. Risk factors of delayed detachment and migration of the stent were analyzed. The median stent defecation time was 5.6 months and the stent was not expelled after 1 year in 33 patients (20.7%). Stent migration was detected in 11 patients (6.9%); the destination was always the hepatic duct. Stent-related complications were observed in 2 cases (1.3%). There were no significant risk factors of delayed detachment of the stent. Stent length ≤25 mm was the only significant predictive risk factor of stent migration into the hepatic duct in multivariate analysis. The low rate of stent-related complications and the absence of serious adverse effects observed in this study justifies that the placement of the internal stent during pancreaticoduodenectomy. Cases with delayed defecation require close and long-term follow-up, especially if a short stent was used.

Application of duct-to-mucosa continuous anastomosis in the pancreaticojejunostomy

Objective: Pancreaticojejunostomy is the most important anastomosis in Whipple operations, it's closely related to the pancreatic fistula. Present a variety of pancreatic enteric anastomosis methods have advantages and disadvantages, this study was to explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods: Clinical data from June 2013 to June 2015 of 165 pancreaticoduodenectomy resection patients were retrospectively analyzed, at the FourthHospital ofHebeiMedicalUniversity,HepatobiliarySurgery.Of the patients, 53 patients with Prolene line continuous duct-to-mucosa, and 112 patients with end-to-side of pancreatic anastomosis were used. Diagnostic criteria referenced the International pancreatic fistula Study Group (ISGPF) defined in 2005. Statistical analysis was performed with the c2 test. A probability value of less than 0.05 was considered statistically significant. Descriptionof operateprocess: Select themainpancreatic ductdiameterover 1.5mm patients. Briefly, upon completion of the PD, the pancreatic remnant was mobilized for 1e2 cm to allow adequate placement of the posterior outer-layer sutures.Find the main pancreatic duct, and suture the bleeding section. The posterior outer-layer anastomosis was performed by using continuous suture technique. Generally, double needle 4-0 prolene sutures were placed starting at the pancreatic remnant andwere continued through the seromuscular layer of the backwall of the jejunum.A 2mmdiameter hole was poked on the jejunum nearing the main pancreatic duct. Double needle 5-0 prolene line continuous suture the whole jejunal wall and the paries posterior of pancreatic duct. Select appropriate diameter internal plastic stent, the end of the stent was positioned within the pancreatic duct. Place the other end of the stent into the jejunum. Then the similar process was performedwith 5-0 prolene line continuous suturing the whole jejunal wall and the antetheca of pancreatic duct. Finally 4-0Prolene continuous suture the seromuscular layer of the jejunum and the anterior wall of pancreas. Results: The incidence of pancreatic fistulas in patients with prolene line continuous suture was 3.8%(2/53), and in those with end-to-side suture it was 15.2% (17/112) (P < 0.05). According to the international clinical grading system, grade A of POPF was found in 2 patients of the prolene line continuous suture group, and were successfully discharged under the conservative treatment. Conclusion: This method of duct-to-mucosa anastomosis with Prolene line continuous suturing is simple and time-saving with obviously reducing incidence of pancreatic fistula. It's continuous anastomosis of main pancreatic duct and the whole jejunum layer, exactly, not easy to occur pancreatic fistula, less affected by the pancreas texture. The Prolene thread and Needle as a whole, lines of smooth, less friction, is suitable for continuous anastomosis. This method of anastomosis is proved to be safe and efficient in preventing pancreatic fistula.

Application value of end-to-side closed in situ pancreaticojejunostomy in pancreaticoduodenectomy

Objective To explore the application value of end-to-side closed in situ pancreaticojejunostomy in pancreaticoduodenectomy. Methods The clinical data of 22 patients with obstructive jaundice who were admitted to the Second Affiliated Hospital of Harbin Medical University from January to March 2014 were retrospectively analyzed. All the patients were explored whether tumors invaded inferior vena cava, superior mesenteric vein and portal vein after gallbladder decompression under general anesthesia by tracheal intubation. The standard or extended pancreaticoduodenectomy was applied according to the intraoperative results. The method of pancreaticojejunostomy was end-to-side closed in situ anastomosis of pancreatic duct and jejunal seromuscular layer. The operation time, intraoperative blood loss, postoperative gastrointestinal function recovery time, amylase concentration of drainage at postoperative day 1, 3, 5, postoperative complication, pathological classification and duration of hospital stay were observed. Patients were followed up by outpatient examination and telephone interview till May 2014. The out-patient follow-up included color Doppler ultrasound examination of effusion near the pancreatic stump, and the telephone interview included whether there were diarrhea of exocrine pancreatic insufficiency. Measurement data with normal distribution were presented as ±s (range), and measurement data with skewed distribution as M(range). Results All the 22 patients underwent successfully the operation, including 17 undergoing standard pancreaticoduodenectomy and 5 undergoing extended pancreaticoduodenectomy, with end-to-side closed in situ anastomosis of pancreatic duct and jejuna seromuscular layer. The operation time of pancreaticoduodenectomy and end-to-side closed in situ pancreaticojejunostomy were (313±37)minutes (range, 228-360 minutes) and(13±4)minutes (7-22 minutes), respectively. The intraoperative blood loss was (400±207)mL (range, 100-800 mL). The mean tumor size was 3.69 cm2 (range, 0.72-1.68 cm2). The recovery time of gastrointestinal function was (5±2)days (range, 4-7 days). The serum amylase at postoperative day 1, 3, 5 in the 21 patients was (145±30)U/L (range, 116-180 U/L), (136±40)U/L (range, 105-176 U/L), (147±38)U/L (range, 110-175 U/L), and the drainage amylase was (220±56)U/L (range, 172-289 U/L), (240±54)U/L (range, 192-300 U/L), (245±52)U/L (range, 190-298 U/L), respectively. The serum amylase at postoperative day 1, 3, 5 in the patient with pancreatic fistula was 156 U/L, 178 U/L and 177 U/L, and the drainage fluid amylase was 500 U/L, 620 U/L and 605 U/L, respectively. There was 1 patient in the 22 patients with pancreatic duct stent and without death. Among the 4 patients with postoperative complications, 1 patient with grade A postoperative pancreatic fistula recovered after continuous external drainage, the other 3 including 1 case of infection, 1 case of pneumonia and 1 of stress ulcer bleeding also recovered after symptomatic and supportive treatment. Postoperative pathological examinations of the 22 patients showed 12 cases of ductal adenocarcinoma, 2 of neuroendocine tumors, 1 of simple cyst, 1 of cystadenocarcinoma, 1 of squamous carcinoma, 1 of adenocarcinoma, 1 of ampullary carcinoma, 1 of tubular adenoma, 1 of leiomyoma and 1 of atypical intraductal hyperplasia. The average length of hospital stay was (11±3)days (range, 2-15 days). There were no effusion near the pancreatic stump showed in color Doppler ultrasound examination and diarrhea of exocrine pancreatic insufficiency. Conclusion End-to-side closed in situ pancreaticojejunostomy is safe and feasible, and can be applied to any pancreatic duct size and texture. Key words: Obstructive jaundice; Pancreaticoduodenectomy; Closed pancreaticojejunostomy; Pancreatic fistula

Reliability of Continuous Suture of Pancreaticojejunostomy after Pancreaticoduodenectomy

Currently, there seems to be no optimized method of pancreaticojejunostomy, and numerous modifications have been used to reduce postoperative pancreatic fistula after pancreaticoduodenectomy. The aim of the present study was to assess the efficacy of continuous sutures for duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy and find predictive risk factors of postoperative pancreatic fistula. We retrospectively reviewed the medical records of 112 patients who underwent pancreaticoduodenectomy, which included patient's demographics, disease-related factors and operative risk factors. Between the interrupted suture and continuous suture groups, there was no significant difference in presence of preoperative biliary drainage, pancreas texture, the pancreatic duct diameter and the prevalence of coronary artery disease. Postoperative pancreatic fistula developed in 21 (18.8%) of the 112 patients who underwent pancreaticoduodenectomy. Only preoperative biliary drainage and operation type showed significant differences for developing pancreatic fistula in a multivariate analysis. The study revealed that the incidence of pancreatic fistula was similar in both the continuous and interrupted suture groups of pancreaticojejunostomy. Continuous suture group had shorter operative time, less damage, fewer knots and less tension than interrupted sutures. Therefore, we concluded that the continuous suture method is feasible and safe to apply to reconstructing pancreaticojejunostomy.

Binding pancreaticojejunostomy – a safe and reliable anastomosis procedure

Over the past one hundred years, the development of pancreaticoduodenectomy (PD) has always involved the struggle against pancreatic leakage. Until now, leakage of the pancreatic anastomosis has remained a common and serious complication after PD. Various methods of dealing with the pancreatic stump for prevention of pancreatic anastomotic leakage have been described. No matter which method is used, however, pancreatic anastomotic leakage is still most likely to occur when anastomosis involves a normal and soft pancreas. To perform a safe and reliable pancreaticoenteric anastomosis, we investigated the risk factors and potential mechanisms of occurrence of pancreatic leakage, including leakage from the needle hole and from the seam between two anastomosed structures, blood supply to the anastomosis and tension at the anastomosis. Based on these findings, we established a new pancreaticoenteric anastomosis procedure - binding pancreaticojejunostomy. The unique aspects of this procedure are as follows. The sero-muscular sheath of jejunum is bound to the invaginated pancreatic stump, so as to seal the gap between them; mucosa of the segment of jejunum that would eventually be in contact with the pancreatic stump is destroyed either chemically or by electric coagulation to promote healing. There is no needle hole on the jejunal surface of the anastomotic site. From 1996 to 2003, a total of 227 consecutive patients were treated with this type of pancreaticojejunostomy in this institution. None of the patients developed a pancreatic anastomotic leak. Binding pancreaticojejunostomy is a safe and reliable anastomotic procedure to effectively minimize leakage even when the texture of the pancreas is soft and normal.

History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique.

The history of pancreaticojejunostomy in pancreaticoduodenectomy is described. Many types of operations have been devised in search of a more reliable method of anastomosis. To perform a safe and reliable pancreaticoenteric anastomosis it is necessary to understand the organ characteristics of the pancreas. We investigated factors required for a reliable pancreaticojejunostomy and devised a new surgical technique that meets those requirements. We introduce the theoretical substantiation and clinical usefulness of our new surgical technique while reviewing the history of pancreaticojejunostomy after pancreaticoduodenectomy. The unique aspect of our method is approximation of the pancreas stump and jejunal wall by six to eight interrupted sutures. It is speculated that too many sutures and tying too tight in the anastomosis may cause ischemia and necrosis of the pancreatic stump by restricting the tissue blood flow. Our method allows us not only to reduce the number of sutures, but also to avoid some of the complicated manipulations done in any other existing methods. The newly devised pancreaticojejunostomy is an excellent surgical technique with anastomotic failure seen in only two patients and no deaths out of 162 consecutive patients.