A standardized technique for safe pancreaticojejunostomy: Pair-Watch suturing technique

Abstract

AIM:To prevent pancreatic leakage after pancreaticojejunostomy, we designed a new standardized technique that we term the "Pair-Watch suturing technique". METHODS:Before anastomosis, we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct. The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side, and a total of 7 stitches were put on the posterior wall, followed by the 5 stitches on the anterior wall. Using this technique, twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct. In all cases the amylase activity of the drain were measured. A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading. RESULTS:From March 2007 to July 2008, 29 consecutive cases underwent pancreaticojejunostomy using this technique. Pathologic examination results showed pancreatic carcinoma (n = 14), intraductal papillary-mucinous neoplasm (n = 10), intraductal papillary-mucinous carcinoma (n = 1), carcinoma of ampulla of Vater (n=1), carcinoma of extrahepatic bile duct (n = 1), metastasis of renal cell carcinoma (n = 1), and duodenal carcinoma (n = 1). Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure. The mean diameter of main pancreatic duct was 3.4 mm (range 2-7 mm). Three patients were recognized as having an amylase level greater than 3 times the serum amylase level, but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment. None of the cases developed complications such as hemorrhage, abdominal abscess, and pulmonary infection. There was no postoperative mortality. CONCLUSION:Our technique is less complicated than other methods and very secure, providing reliable anastomosis for any size of pancreatic duct.

Stented pancreaticojejunostomy (with video)

“…Operative technique of pancreaticojejunostomy [10] with video Here we describe our technique of end-to-side pancreaticojejunostomy in a typical case in which the caliber of the main pancreatic duct is around 3 mm with normal and soft pancreatic parenchyma. After proximal or medial pancreatectomy, the cut end of the distal pancreas is mobilized for approximately 2 cm to allow the placement of interrupted sutures to the posterior surface of the pancreas (Fig.…”

“…It should be therefore emphasized that a standardized approach to pancreatic anastomosis and the consistent practice of a single technique can help to reduce the incidence of complications [8]. To effectively prevent the development of pancreatic leakage, we developed a new standardized technique of duct-to-mucosa pancreaticojejunostomy, named the ''pair-watch suturing technique'' [10]. We consider that this technique will be suitable as a standard technique for high-grade difficult surgery in the hepatobiliary-pancreatic field.…”

Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: association of pancreatic exocrine deficiency and infection

“…Three years later, a follow-up CT scan disclosed increased size of the cystic mass (45 mm diameter) with dilatation of main pancreatic duct. With a diagnosis of mixed-type IPMN, she underwent PD with reconstruction by a modification of Child's method in antecolic fashion: end-to-side pancreaticojejunostomy (duct-to-mucosa anastomosis) [13], followed by standard end-to-side choledochojejunostomy and end-to-side gastrojejunostomy with Braun side-to-side jejunojejunostomy. Moderate pancreatic fibrosis was noted, and the pancreas was transected at a point overlying the SMA.…”

“…With a diagnosis of branch duct type IPMN, she underwent PD. The reconstruction procedures were completed using a modification of Child's method in antecolic fashion: end-to-side pancreaticojejunostomy (duct-tomucosa anastomosis) [13], followed by standard end-to-side choledochojejunostomy and end-to-side gastrojejunostomy with Braun side-to-side jejunojejunostomy. At operation, moderate pancreatic fibrosis was noted, and the pancreas was transected to the left of the superior mesenteric artery (SMA).…”

Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium

“…Other patients underwent surgery without any preoperative treatments. Pancreaticojejunostomy is performed using the Pair-Watch suturing technique with 12 stitches regardless of the caliber of the pancreatic duct [17] and all the patients underwent feeding jejunostomy. …”