Effect of end-to-side inverted mattress pancreaticojejunostomy following central pancreatectomy on the prevention of pancreatic fistula

Abstract

PurposeCentral pancreatectomy (CP) may be indicated for the treatment of benign or low-grade malignant tumor in the neck and proximal body of the pancreas. Pancreatic fistula is one of the most common complications after CP. In this study, we suggested an inverted mattress pancreaticojejunostomy (IM-PJ) technique to decrease the risk of pancreatic fistula.MethodsBetween 2010 and 2015, CP was performed with IM-PJ for 10 consecutive patients with a benign or low-grade malignant tumor in the neck and proximal body of the pancreas. All clinical and pathological data were analyzed retrospectively.ResultsMedian age was 56.4 years (range, 17–75 years). Median surgery duration was 286 minutes (range, 205–410 minutes). In all cases, the distal stump was reconstructed using the IM-PJ method. Median duration of hospital stay was 23.8 days (range, 9–53 days). No patient mortality occurred. Pancreatic fistula developed in 9 cases (90%); however, all fistulas were grade A and resolved without surgical or radiological intervention. Nine patients remain well with no recurrence or new endocrine or exocrine dysfunction.ConclusionOur results demonstrate that the outcomes of CP with IM-PJ are reasonable for prevention of pancreatic fistula following CP.

Utilization of end to side inverted mattress pancreaticojejunostomy for Duval procedure: A case report

“…As previously published, our data showed that IM-PJ reduced the risk of Grade C POPF and serious complications such as a gastroduodenal artery pseudoaneurysm after pancreaticoduodenectmy [ 4 ]. No pancreatic fistula occurred from IM-PJ after a central pancreatectomy [ 5 ]. Based on our experiences of reporting the safety of IM-PJ for a pancreaticoduodenectmy and central pancreatectomy, we decided to apply the same technique for this patient.…”

“…Compared to the conventional “duct to mucosa” technique after a pancreaticoduodenectmy, the IM-PJ, effectively reduced the risk of grade C POPF and serious complications such as a gastroduodenal artery pseudoaneurysm [ 4 ]. Similarly, no pancreatic fistula occurred from IM-PJ after a central pancreatectomy [ 5 ]. Based on the previous reports of low morbidity following IM-PJ, we decided to apply this technique after a distal pancreatectomy for a patient with chronic pancreatitis with proximal pancreatic duct obstruction, caused by an impacted stone, requiring the Duval procedure.…”

Pancreatoduodenectomy with a novel pancreato-jejunal anastomosis by the single-layer long parenchymal traverse technique (Siriwardena technique): Early demonstration of safety in practice development in Sri Lanka.

“…However, postoperative morbidity after PD remains high with the pancreato-enteric anastomosis being a major source of complications accounts for about 5% to 30% of the cases (5,6,7). Various modifications of the pancreatico jejuna anastomosis like binding pancreaticojejunostomy, inverted mattress pancreaticojejunostomy, papillary-like pancreaticojejunostomy have shown a benefit, yet none has become the standard and foolproof method in reducing the incidence of POPF (8,9,10). Therefore this short paper describes the transcription of a new technique used in Manchester, the UK which is an end to side, duct to mucosa pancreaticojejunostomy with an insertion of a transanastomotic silicone stent.…”