Ann Surg Treat Res.  2016 Feb;90(2):64-71. 10.4174/astr.2016.90.2.64.

A simple pancreaticojejunostomy technique for hard pancreases using only two transpancreatic sutures with buttresses: a comparison with the previous pancreaticogastrostomy and dunking methods

• Kim EY
• You YK
• Kim DG
• Hong TH

• KMID: 2166824
• DOI: http://doi.org/10.4174/astr.2016.90.2.64

Abstract

PURPOSE
In this study, we introduced a novel technique, the pancreaticojejunostomy (PJ), which uses only two transpancreatic sutures with buttresses (PJt), and compared the surgical outcomes with previously used methods, especially for hard pancreases.
METHODS
A total of 101 patients who underwent pancreaticoduodenectomy with hard pancreases were enrolled and divided into 3 groups according to the method of pancreaticoenteric anastomosis: 30 patients (29.7%) underwent the conventional dunking method (Du), 31 patients (30.7%) underwent pancreaticogastrostomy using transpancreatic sutures (PGt) and 40 patients (39.6%) underwent PJ using transpancreatic sutures (PJt). The surgical outcomes were compared according to the type of anastomosis to analyze the feasibility and ease of each technique.
RESULTS
The overall operative time was shorter in the PJt group (325.1 +/- 63.8 minutes) than in the PGt group (367.3 +/- 70.5 minutes) or the Du group (412.0 +/- 38.2 minutes, P < 0.001). In terms of pancreaticoenteric anastomosis time, it was also shorter in the PJt group (10.3 +/- 3.5 minutes) than in the Du group (20.7 +/- 0.7 minutes) or the PGt group (16.8 +/- 5.4 minutes, P = 0.005). Significant postoperative pancreatic fistula (POPF) developed in 2 cases (6.7%) in the Du group, whereas there were no POPF cases in the PGt or PJt groups (P = 0.086). Overall postoperative morbidities occurred in 31 cases (30.7%), and there were no significant differences among the 3 groups (P = 0.692).
CONCLUSION
The novel PJ technique, which uses only two transpancreatic sutures with buttresses, is a very simple, easy and secure method for hard pancreases and can be performed in a shorter amount of time compared with conventional methods.

Keyword

Pancreas; Pancreaticoduodenectomy; Pancreaticojejunostomy

MeSH Terms

Humans
Methods*
Operative Time
Pancreas*
Pancreatic Fistula
Pancreaticoduodenectomy
Pancreaticojejunostomy*
Sutures*

Figure

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  Fig. 1 A schematic diagram of pancreaticogastrostomy using two transpancreatic sutures with buttresses through a gastrostomy made in the anterior wall of stomach.

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  Fig. 2 The hardness of the pancreas has been estimated based on the surgeon's judgment during the operation and more objectively using a durometer to measure the hardness of the pancreas.

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  Fig. 3 Schematic diagrams of pancreaticogastrostomy using two transpancreatic sutures with buttresses (A) and pancreaticojejunostomy using two transpancreatic sutures with buttresses (B) after the completion of the reconstruction.

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  Fig. 4 Operative view (A, B) and schematic diagram (C) of pancreaticojejunostomy using two transpancreatic sutures with buttresses.

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