Binding pancreaticojejunostomy: 150 consecutive cases without leakage

Abstract

The objective of this study was to verify the safety of a new technique termed "binding pancreaticojejunostomy" in a prospective cohort study. Pancreaticojejunal anastomostic leakage is a major cause of morbidity and mortality after pancreaticoduodenectomy. To prevent the development of pancreatic fistulas, we designed a special technique that we termed binding pancreaticojejunostomy. Binding pancreaticojejunostomy entails binding 3 cm of the serosamuscular sheath of the jejunum to the intussuscepted pancreatic stump. From January 1996 to May 2001, a total of 150 consecutive patients were treated with this type of pancreaticojejunostomy, including typical pancreaticoduodenectomy in 120, hepatopancreaticoduodenectomy in 17, pylorus-preserving pancreaticoduodenectomy in 10, and duodenal-preserving resection of the head of the pancreas in three. None of the patients developed pancreatic fistulas. The overall morbidity was 31.3%. The following complications occurred: gastrointestinal bleeding in six, pulmonary infection in 12, wound infection in 20, delayed gastric emptying in three, incision dehiscence in four, and hepatic insufficiency in two. The mean postoperative hospital stay was 19.8 +/- 5 days. Binding pancreaticojejunostomy is a safe, simple, and effective technique.

Binding Versus Conventional Pancreaticojejunostomy After Pancreaticoduodenectomy: A Case-Matched Study

“…1,13 Several techniques have been described for safe surgical management of the pancreatic remnant, including main duct stenting, pancreaticogastrostomy, and pancreaticojejunostomy with duct to mucosa anastomosis or intussusception, but none has a clearly proven superiority over the others and subsequently became widely accepted. 10,[17][18][19][20][21][22] Recently, Peng et al 23,24 described a new anastomosis technique, called binding pancreaticojejunostomy (BPJ).…”

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

“…The median duration of surgery of 88 patients was 3.8 h (range 3-6.5) and the median time to perform pancreaticojejunostomy was 13.3 min (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The median blood loss was 750 ml (range 300-1,800), 36 of 88 patients needed transfusion and the median blood transfusion for 56 patients was 380 mL (range 200-1,200).…”

“…When compared with other studies [27][28][29][30][31][32][33], we found that the results of present study were much better and very encouraging. Except of the above-mentioned, the advantages of our technique are: (1) simple, only two to three transpancreatic U-sutures are placed; (2) easy, no need of isolation of long segment of remnant pancreas as described by Peng et al [25], pancreatic stump could be easily invaginated into the jejunum loop through straining the Usutures; (3) rapid, the median time to perform pancreaticojejunostomy using this technique was only 13.3 min (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

“…In review of the literature, Bartoli et al [22] reported incidence of pancreatic fistula with end-to-side invagination anastomosis (26%) was significantly higher than with ductto-mucosa (16%) anastomosis. Matsumoto et al [23], in a retrospective study of 100 patients, showed a pancreatic fistula rate of 4.2% after duct-to-mucosa anastomosis versus 26.4% after invagination anastomosis. In study on 133 patients who underwent PD, Lee et al [5] showed that continuous duct-to-mucosa anastomosis was a safer method, with a significantly lower leakage rate.…”

The effect of somatostatin and its analogs in the prevention of pancreatic fistula after elective pancreatic surgery

“…A number of technical interventions have been suggested to decrease the rate of pancreatic fistula after pancreatic surgery without an accepted consensus [17][18][19][20][21][22][23][24]. The pharmacological approach to prevent anastomotic leak after pancreatic surgery was first described by a German group who reported a reduced morbidity after pancreaticoduodenectomy with perioperative infusion of somatostatin [25].…”