Ann Surg Treat Res.  2017 Nov;93(5):246-251. 10.4174/astr.2017.93.5.246.

Effect of end-to-side inverted mattress pancreaticojejunostomy following central pancreatectomy on the prevention of pancreatic fistula

• Choi YY
• Kim SG
• Hwang YJ
• Kwon HJ

• KMID: 2393989
• DOI: http://doi.org/10.4174/astr.2017.93.5.246

Abstract

PURPOSE
Central pancreatectomy (CP) may be indicated for the treatment of benign or low-grade malignant tumor in the neck and proximal body of the pancreas. Pancreatic fistula is one of the most common complications after CP. In this study, we suggested an inverted mattress pancreaticojejunostomy (IM-PJ) technique to decrease the risk of pancreatic fistula.
METHODS
Between 2010 and 2015, CP was performed with IM-PJ for 10 consecutive patients with a benign or low-grade malignant tumor in the neck and proximal body of the pancreas. All clinical and pathological data were analyzed retrospectively.
RESULTS
Median age was 56.4 years (range, 17-75 years). Median surgery duration was 286 minutes (range, 205-410 minutes). In all cases, the distal stump was reconstructed using the IM-PJ method. Median duration of hospital stay was 23.8 days (range, 9-53 days). No patient mortality occurred. Pancreatic fistula developed in 9 cases (90%); however, all fistulas were grade A and resolved without surgical or radiological intervention. Nine patients remain well with no recurrence or new endocrine or exocrine dysfunction.
CONCLUSION
Our results demonstrate that the outcomes of CP with IM-PJ are reasonable for prevention of pancreatic fistula following CP.

Keyword

Pancreatectomy; Pancreaticojejunostomy; Pancreatic fistula

MeSH Terms

Fistula
Humans
Length of Stay
Methods
Mortality
Neck
Pancreas
Pancreatectomy*
Pancreatic Fistula*
Pancreaticojejunostomy*
Recurrence
Retrospective Studies

Figure

• 

  Fig. 1 Inverted mattress pancreaticojejunostomy technique. (A) Three to 4 U-shaped mattress sutures were placed starting at the serosa of the posterior jejunal wall. The inverted seromuscular stitches were made going in-out. (B) These sutures penetrated the pancreatic remnant in a straight manner. (C) After penetrating the pancreatic parenchyma with a needle, the seromuscular layer of the anterior jejunal wall was inverted with the sutures going out-in, followed by a full thickness stitch of the anterior jejunal wall going in-out. (D) The U-shaped sutures were pulled with adequate tension and tied at the anterior wall and both corners of the jejunum. (E) A p-duct stent was fixed on theRoux limb stump using three or four sutures for prevention of spontaneous removal.

Reference

1. Letton AH, Wilson JP. Traumatic severance of pancreas treated by Roux-Y anastomosis. Surg Gynecol Obstet. 1959; 109:473–478.

2. Zhou YM, Zhang XF, Wu LP, Su X, Li B, Shi LH. Pancreatic fistula after central pancreatectomy: case series and review of the literature. Hepatobiliary Pancreat Dis Int. 2014; 13:203–208.

3. Goldstein MJ, Toman J, Chabot JA. Pancreaticogastrostomy: a novel application after central pancreatectomy. J Am Coll Surg. 2004; 198:871–876.

4. Iacono C, Verlato G, Ruzzenente A, Campagnaro T, Bacchelli C, Valdegamberi A, et al. Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg. 2013; 100:873–885.

5. Kwon HJ, Ha HT, Choi YY, Kim SG. The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon's experience. Ann Surg Treat Res. 2015; 89:61–67.

6. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8–13.

7. Brown KM, Shoup M, Abodeely A, Hodul P, Brems JJ, Aranha GV. Central pancreatectomy for benign pancreatic lesions. HPB (Oxford). 2006; 8:142–147.

8. Ocuin LM, Sarmiento JM, Staley CA, Galloway JR, Johnson CD, Wood WC, et al. Comparison of central and extended left pancreatectomy for lesions of the pancreatic neck. Ann Surg Oncol. 2008; 15:2096–2103.

9. Goudard Y, Gaujoux S, Dokmak S, Cros J, Couvelard A, Palazzo M, et al. Reappraisal of central pancreatectomy a 12-year single-center experience. JAMA Surg. 2014; 149:356–363.

10. Zhou J, Dong M, Kong F, Li Y, Tian Y. Central pancreatectomy for benign tumors of the neck and body of the pancreas: report of eight cases. J Surg Oncol. 2009; 100:273–276.

11. Xiang GM, Tan CL, Zhang H, Ran X, Mai G, Liu XB. Central pancreatectomy for benign or borderline lesions of the pancreatic neck: a single centre experience and literature review. Hepatogastroenterology. 2012; 59:1286–1289.

12. Venara A, de Franco V, Mucci S, Frampas E, Lermite E, Regenet N, et al. Central pancreatectomy: comparison of results according to the type of anastomosis. J Visc Surg. 2012; 149:e153–e158.

13. Sauvanet A, Partensky C, Sastre B, Gigot JF, Fagniez PL, Tuech JJ, et al. Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery. 2002; 132:836–843.

14. Zhou Y, Yang C, Wang S, Chen J, Li B. Does external pancreatic duct stent decrease pancreatic fistula rate after pancreatic resection?: a meta-analysis. Pancreatology. 2011; 11:362–370.

15. Kang CM, Lee JM, Kim MW, Yoon DS, Park JS, Lee WJ. Experiences in central pancreatectomy. Dig Surg. 2011; 28:57–62.

16. Jalleh RP, Williamson RC. Pancreatic exocrine and endocrine function after operations for chronic pancreatitis. Ann Surg. 1992; 216:656–662.

17. Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001; 25:452–460.

18. Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg. 2002; 236:612–618.