Ann Surg Treat Res.  2022 Feb;102(2):110-116. 10.4174/astr.2022.102.2.110.

A reinforced suture method for stapled gastrointestinal anastomosis to reduce gastrointestinal hemorrhage during Whipple operation in laparoscopy

Affiliations
  • 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • 2Department of Pathology, Chongqing Medical University, Chongqing, China

Abstract

Purpose
Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high.
Methods
One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods.
Results
Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001).
Conclusion
Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

Keyword

Pancreaticoduodenectomy; Postoperative hemorrhage; Surgical anastomosis

Figure

  • Fig. 1 Illustrations and photographies of the reinforced method in gastrointestinal anastomosis. (A, B) A 4-0 pyloric suture called as the reinforced line (blue line) sewn and reinforced from the posterior wall of the newly-built digestive tract along the anastomotic nails in the lumen by the continuous whole layer fashion; the stitch spacing was about 5 mm, and exposed the anastomotic nails in the deep and anterior wall of new digestive tract by clamping the suture instead of the intestinal lumen to tract the tract. (C, D) The reinforced line was sewn to the outside of the lumen and another 4-0 pyloric suture called as the repair line (green line) was sewn to the anastomosis and fixed with the reinforced line. The repair line was used continuous suturing through the full layer of the intestine to repair the defect of the anastomosis and the stitch spacing was also about 5 mm.


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