Pancreatic Fistula after Pancreaticoduodenectomy: A Comparison between the Two Pancreaticojejunostomy Methods for Approximating the Pancreatic Parenchyma to the Jejunal Seromuscular Layer: Interrupted Vs. Continuous Stitches

Lee, Seung Eun; Kim, Sun Whe; Jang, Jin Young; Han, Sung Sik; Park, Yong Hyun

Abstract

PURPOSE: Leakage of the pancreaticojejunal anastomosis has been a major complication after pancreaticoduodenectomy. Over the past decades, various measures directed towards prevention of pancreatic leakage have been studied. The purpose of this study is to find better operative technique as comparing the interrupted stitches with the continuous stitches for the outer layer of the panceaticojejunostomy, ie. the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage.
METHODS
During the period January 1997 to October 2004, 138 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with the interrupted suture for outer layer of the pancreaticojejunostomy and 173 patients with the continuous suture at our institution by one surgeon. A pancreatic fistula was defined as drainage of more than 30 ml of fluid with an amylase level higher than 600 U/dl on or after postoperative week 1. Major pancreatic leakage was defined as drainage of more than 200 ml of fluid or development of the intra-abdominal abscess or the pseudoaneurysm due to pancreatic fistula. Statistical differences were verified using chi-square test.
RESULTS
There were no differences between the two groups in the diagnosis, texture of the pancreas, using of sandostatin and staging. For the interrupted suture group, operative time was 35.4+/-4.8 minutes, and for the continuous group, 29.1+/-3.9 minutes (p<0.001). Pancreatic fistula occurred in 14 interrupted suture cases (10.14%) and in 10 continuous suture cases (5.75%)(p=0.126). Major pancreatic leakage developed in 3 interrupted suture patients (2.17%) and 2 continuous suture patients (1.15%)(p=0.168).
CONCLUSION
The two methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer revealed no significant difference in the development of pancreatic fistula. However, for the continuous suture group, operative time was significantly reduced and pancreatic fistula rate was decreased without increasing morbidity. In
conclusion
, the continuous suture is more feasible and safe in performing pancreaticojejunostomy.