Korean J Hepatobiliary Pancreat Surg.  2014 Feb;18(1):21-25. 10.14701/kjhbps.2014.18.1.21.

Preliminary results of binding pancreaticojejunostomy

• Kim JM
• Hong JB
• Shin WY
• Choe YM
• Lee GY
• Ahn SI

• KMID: 1890076
• DOI: http://doi.org/10.14701/kjhbps.2014.18.1.21

Abstract

BACKGROUNDS/AIMS
The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.
METHODS
We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines.
RESULTS
Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management.
CONCLUSIONS
The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

Keyword

Binding pancreaticojejunostomy; Pancreaticoduodenectomy; Pancreatic fistula

MeSH Terms

Amylases
Humans
Male
Pancreatic Fistula
Pancreaticoduodenectomy
Pancreaticojejunostomy*
Retrospective Studies
Amylases

Figure

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  Fig. 1 Surgical technique of binding pancreaticojejunostomy presented by Peng et al.6 (A) The pancreatic stump and the everted jejunum are brought together and sutured with silk. Care is taken to suture the mucosa only. (B) The remnant of the pancreas in the lumen of the jejunum is looped around and ligated together. A bundle of vessels is spared to maintain an intact blood supply to the jejunum cut end.

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  Fig. 2 Presentation of morbidity and mortality cases. (A) Computed tomography 7 days after BPJ due to an ampulla of Vater cancer. There was a minimal amount of fluid collection in the subhepatic space. In the operative field, the pancreaticojejunostomy had become totally disrupted and there was bleeding at the cut surface of the pancreas. The patient underwent completion pancreatectomy. (B) Computed tomography at 11 days after pylorus-preserving pancreaticoduodenectomy due to distal bile duct cancer. There was a loculated hematoma with high attenuated fluid in the right subphrenic, subcapsular space and the right anterior pararenal spaces. This suggested extravasation of the contrast media with active bleeding. The patient received completion pancreatectomy, but he expired due to intraperitoneal abscess and multi-organ failure.

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