Ann Surg Treat Res.  2015 Aug;89(2):61-67. 10.4174/astr.2015.89.2.61.

The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon's experience

• Kwon HJ
• Ha HT
• Choi YY
• Kim SG

• KMID: 2166972
• DOI: http://doi.org/10.4174/astr.2015.89.2.61

Abstract

PURPOSE
Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call "inverted mattress PJ (IM)". The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF.
METHODS
From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs.
RESULTS
The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P < 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths.
CONCLUSION
IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.

Keyword

Pancreaticojejunostomy; Pancreatic fistula

MeSH Terms

Arrhythmias, Cardiac
Candida
Cause of Death
Humans
Incidence
Pancreatic Fistula*
Pancreaticoduodenectomy
Pancreaticojejunostomy*
Sepsis
Sutures

Figure

• 

  Fig. 1 (A) Three to four U-shaped mattress sutures (4-0 Prolene, Ethicon Inc., Somerville, NJ, USA) 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. The cross-sectional view of the pancreaticojejunostomy shows the pancreatic remnant fully invaginated into the lumen of the jejunum. Tying all stitches encloses the jejunal opening around the pancreas remnant.

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