The Duct to mucosa method for a pancreaticojejun-ostomy:continuous stitches modification

Jang, Jin Young

Abstract

Pancreatic anastomosis is a main pitfall when performing a proximal pancreatectomy due to significant morbidity and associated mortality. In selecting a pancreatic anastomosis method, many factors must be considered such as safety, convenience, preservation of function and efficiency/economy. We discuss the merits and faults of various pancreatic anastomosis methods based on previous criteria. Based on our past experience, we now perform a duct to mucosa method for a pancreaticojejunostomy, especially using a continuous stitched method. Anastomosis for the remnant pancreas was performed between the pancreas and jejunum by a two layer pancreaticojejunostomy. The outer layer consisted of remnant pancreatic parenchyme and a seromuscular layer of jejunum and an interrupted suture or continuous suture between these two was performed with 4-0 ProlenTM (Ethicon, Somerville, NJ). The inner layer consisted of the pancreatic duct and mucosa of the jejunum and an interrupted suture for duct-to-mucosa was performed with 5-0 PDSTM II (Ethicon, Somerville, NJ). A polyethylene tube was inserted into the pancreatic duct as a stent in all patients and external drainage was performed. After adopting this method, the operative time was significantly reduced and the pancreatic fistula rate (5.8%) was decreased without increasing morbidity. Considering the long-term preservation of pancreas function, the duct to mucosa pancreaticojejunostomy is a preferred anastomosis method, and the continuous stitches method is more efficient and economic for performing a pancreaticojejunostomy.