A Comparison of Two Invagination Techniques for Pancreatojejunostomy after Pancreatoduodenectomy

Abstract

Background. The aim of the study was to compare two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy. Methods. For effective prevention of the development of pancreatic leakage, we modified invagination technique that we term the “serous touch.” We analysed the diameter of the main pancreatic duct, the texture of the remnant pancreas, the method of the reconstruction, pancreatic external drainage, anastomotic procedure time, histopathological examination, and postoperative complications. Results. Fifty-two patients underwent pancreatoduodenectomy with pancreatojejunostomy using “serous touch” technique (ST group) and 52 classic pancreatojejunostomy (C group). In the ST group one patient (1.9%) was diagnosed as grade B pancreatic fistula, and no patient experienced fistula grade A or C. In the C group 6 patients (11.5%) were diagnosed as fistula grade A, 1 (1.9%) patient as fistula grade B, and 1 (1.9%) patient as fistula grade C. There was a significant statistical difference in incidents of pancreatic fistula (P < 0.05) and no statistical difference in other postoperative complications or mortality in comparison group. Anastomosis time was statistically shorter in the ST group. Conclusions. “Serous touch” technique appeared to be easy, safe, associated with fewer incidences of pancreatic fistulas, and less time consuming in comparison with classical pancreatojejunostomy.

Single Center, Propensity Score Matching Analysis of Different Reconstruction Techniques following Pancreatoduodenectomy

“…In order not to occlude the pancreatic duct, an externally draining stent is inserted. Finally, resembling the ''telescope'' or ''dunking'' technique [37], the pancreas stump becomes completely enclosed by the jejunal loop (Figure 1).…”

Pancreaticojejunostomy—a review of modern techniques

“…Next, two U-sutures (starting from the outside of the intestine) are used to pull the pancreatic stump into the cuff, creating an end-to-end anastomosis. The adherence of 2-3 cm of the intestinal serosa to the pancreatic capsule should subsequently lead to prevention of pancreatic leakage [22].…”