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

Affiliations
  • 1Department of Surgery, CHA Gumi Medical Center, Gumi, Korea.
  • 2Department of Surgery, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea. kwonhj95@naver.com

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.


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