Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):412-416. 10.14701/ahbps.22-100.

Utilization of end to side inverted mattress pancreaticojejunostomy for Duval procedure: A case report

• Jeon HJ
• Kim SG

• KMID: 2536393
• DOI: http://doi.org/10.14701/ahbps.22-100

Abstract

Although a pancreaticojejunostomy (PJ) is not required after a distal pancreatectomy in most cases, it needs to be performed to prevent atrophy of the remnant pancreas when the proximal duct is obstructed by a tumor, stone, or etc. In these conditions, the critical postoperative pancreatic fistula (POPF) gives surgeons cause to hesitate before performing a PJ. We previously presented the modified technique of Mattress PJ named “inverted mattress PJ” (IM-PJ) and published improved outcomes in the aspects of POPF after a pancreaticoduodenectomy and a central pancreatectomy. Recently, we had a case of a patient who has chronic pancreatitis with a proximal pancreatic duct obstruction, requiring a distal pancreatectomy and PJ. Based on the previous report, we decided to apply the “inverted mattress PJ” (IM-PJ) technique for a Roux-en Y PJ after a distal pancreatectomy. The patient was discharged after surgery without complications. We reviewed a case of a patient requiring PJ following a distal pancreatectomy and discussed the safety of our technique.

Keyword

Pancreatitis; chronic; Pancreatectomy; Pancreaticojejunostomy; Pancreatic fistula

Figure

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  Fig. 1 (A) Abdominal contrast enhanced computed tomography images show a pancreatic stone that occludes the proximal pancreas. (B) Pancreatic duct dilatation due to proximal pancreatic duct obstruction is identified.

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  Fig. 2 The black arrow shows the resection margin of the pancreas, and the white arrow shows the enlarged pancreatic duct found on preoperative computed tomography.

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  Fig. 3 The black arrows show the pancreaticojejunostomy and the white arrows show an external stent inserted into the pancreatic duct.

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  Fig. 4 (A) Three to four U-shaped mattress sutures (4-0 Prolene) were placed starting at the serosa of the posterior jejunal wall. The inverted seromuscular stitches were made going in-out. (B) 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.

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  Fig. 5 Abdominal contrast enhanced computed tomography (CT) images. (A) The pancreas duct remained dilated seven days after surgery. (B) When the CT was performed at follow-up, three years after the surgery, the diameter of the pancreatic duct (arrow) was reduced when compared with the perioperative period.

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