A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases

Abstract

An invaginated end-to-end pancreaticojejunostomy with two to three transpancreatic U-sutures is simple, rapid, safe, and reliable technique, even in some patients with soft pancreas and small pancreatic duct.

Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy

“…Nevertheless, pancreaticojejunostomy and pancreaticogastrostomy are the most commonly used procedures for POPF prevention. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Anastomosis type between remnant pancreas and jejunum includes end-to-side duct-tomucosa anastomosis, end-to-side (dunking), or end-to-end invagination anastomosis. 2,3,7 Some surgeons found that end-to-side duct-to-mucosa anastomosis was superior to invagination in terms of long-term anastomotic patency and function in a canine model.…”

“…[16][17][18][19][20][21][22] Because POPF after surgery may worsen the early and long-term outcomes for patients undergoing PD, an uncomplicated course is particularly important for patients in this operative group. As described in the A Novel U-Suture for Pancreaticojejunostomy 4339 literature, 5,16,[18][19][20][21][22] there are three important risk factors for POPF, which include patient factor (age, sex, level of jaundice, and others), operation factor (total operation time, blood loss, type of anastomosis, stenting of anastomosis, drain management), and pancreas factor (pancreatic texture, fatty pancreas, pancreatic duct size, blood supply to the cut end, original pathology, and others). Among these many factors, pancreatic texture, pancreatic duct size, and operative techniques have been identified as the most significant factors to influence patient outcome.…”

“…15,16 Over the past 10 years, this technique has been used in 264 patients who underwent a pancreaticojejunostomy after PD and excellent perioperative outcomes have been demonstrated. In this current follow-up article, we revisited this technique to further discuss the clinical efficacy of this surgical approach.…”

Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience

“…B, Kaplan-Meier overall survival curves for patients undergoing minor and major liver resection for hilar cholangiocarcinoma. P=0.300 (Chen et al, 2009). tion and increased hospital cost (Bottger and Junginger, 1999;Trede and Schwall, 1988).…”

“…In 1995, our group established the Chen's U-stitch approach, which was a new technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic transverse U-sutures after PD, and the preliminary results were quite encouraging at that time (Chen et al, 2009). In 88 patients who underwent a transpancreatic U-sutures IPJ PD, only 2 patients (2.2%) developed a grade A POPF.…”