Duct-to-Mucosa vs Invagination for Pancreaticojejunostomy after Pancreaticoduodenectomy: A Prospective, Randomized Controlled Trial from a Single Surgeon

Bai, Xueli; Zhang, Qi; Gao, Shunliang; Lou, Jianying; Li, Guogang; Zhang, Yun; Ma, Tao; Zhang, Hongjie; Xu, Yuanliang

doi:10.1016/j.jamcollsurg.2015.10.003

Cited by 91 publications

(129 citation statements)

References 26 publications

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“…We agree that the outer Lembert suture layer is required to protect the inner duct-to-mucosa layer by reducing the possible tension 17. However, in our experience, once the posterior outer layer has been sutured and tied, it is difficult to identify the pancreatic duct lumen and stent insertion and suturing are challenging.…”

Section: Discussionmentioning

confidence: 70%

“…Also, by anchoring and retracting the anterior inner row sutures, the whole circumference of duct-to-mucosa sutures can be performed in a single step, without worrying about making knots in the posterior row in the face of intervening anterior row sutures. Once the inner layer has been completed, there should be no problem in suture-tying for the seromuscular layer, as described by the other authors 1722…”

Section: Discussionmentioning

confidence: 98%

“…Duct-to-mucosa PJ may be a reasonable choice because it has a lower rate of clinically relevant POPF,17 although some studies have concluded otherwise 818. Since Warren and Cattell described a detailed method for duct-to-mucosa PJ in 1956, many technical modifications have been reported, and today it appears that every large volume center has its own method 16171819.…”

Section: Discussionmentioning

confidence: 99%

“…Since Warren and Cattell described a detailed method for duct-to-mucosa PJ in 1956, many technical modifications have been reported, and today it appears that every large volume center has its own method 16171819. Regardless of the technique adopted, all techniques have two common features.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have tried to avoid this problem by performing ductal20 or stump invagination PJ 21. Although the outer layer can be sutured after the inner layer has been completed,17 suturing and cannulation of a small pancreatic duct are still difficult, if the posterior inner layer is tied first.…”

Section: Discussionmentioning

confidence: 99%

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An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures

Kim

Shin

Lee

et al. 2017

Ann Hepatobiliary Pancreat Surg

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Pancreaticoenteric anastomosis is the origin of postoperative pancreatic fistula (POPF). Although a variety of methods have been proposed to decrease the POPF rate, randomized controlled trials performed so far have failed to demonstrate superiority of any particular method to the others. Cattell-Warren duct-to-mucosa pancreaticojejunostomy (PJ) is a widely practiced procedure. Their method is challenging, especially when the pancreatic duct is small. We assumed that the difficulty resides in the pancreatic duct becoming difficult to access when the posterior row is tied before suturing the anterior row. We have modified the duct-to-mucosa PJ so that the entire circumference of the inner layer can be sutured and tied in one-step by anchoring and retracting the anterior row. The jejunal roux-limb and pancreatic stump are positioned spatially apart, allowing enough space for free needle work. During a 13-year period, 151 patients underwent pancreaticoduodenectomy with this method, and the cumulative POPF and mortality rates were 37.1% and 4.6%, respectively. These rates were stable throughout the study period, implicating a relative independence from surgeons' experience. We believe that our method is intuitive, easy to grasp, and can be readily adopted even by surgeons not accustomed to pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 98%