Pancreaticojejunostomy-securing technique: duct-to-mucosa anastomosis by continuous running suture and parachuting using monofilament absorbable thread

Ohwada, Susumu; Iwazaki, Shigeru; Nakamura, Seiji; Ogawa, Tetsushi; Tanahashi, Yoshihumi; Ikeya, Toshiro; Iino, Yuichi; Morishita, Yasuo

doi:10.1016/s1072-7515(01)00904-8

Cited by 20 publications

(14 citation statements)

References 15 publications

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“…*There were no significant differences between groups. in pancreaticojejunotomy following pancreaticoduodenectomy [17]. We believe that sandwiching fibrin glue between the dorsal and ventral edges of the pancreatic remnant may prevent leakage of pancreatic juice and reinforce the union and attachment of the pancreatic remnant.…”

Section: Discussionmentioning

confidence: 94%

Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy

et al. 1998

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Pancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches. In the sealing group, fibrin glue was sprayed over the closed pancreatic stump and sutures. Alternatively, in the sandwich group fibrin glue was sprayed so as to cover and join the cut surface of the pancreatic remnant, which was then held closed with sutures. Altogether 111 patients were included in the study (90 with gastric cancer, 10 with esophageal cancer, and 11 with pancreatic cancer). Patients were nonrandomly assigned to the sandwich or the sealing group. Morbidity was 21.8% for the patients in the sandwich group versus 33.9% in the sealing group. Pancreatic fistulas occurred in 9.0% of the sandwich group versus 26.8% of the sealing group. The incidence of fistula was thus significantly lower in the sandwich group. The incidence of fistula was also significantly lower in the sandwich group for gastric malignancy patients undergoing extended radical lymphadenectomy down to the paraaortic lymph nodes combined with left adrenalectomy. Of the patients with gastric malignancy, pancreatic fistulas occurred in 9.3% of the sandwich group versus 25.5% of the sealing group. The fibrin glue sandwich technique is simple and reliable and should be valuable for complementing other prophylactic methods of preventing pancreatic fistula.

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Section: Discussionmentioning

confidence: 94%

Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy

et al. 1998

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“…In addition, the surgeon's experience makes a difference to the surgical outcome. [31][32][33][34] The patient volume per surgeon was found to be an independent factor in determining the risk of anastomosis leakage in a recent dual-institution RCT evaluating PF rates in invagination versus duct-to-mucosa PJ. 18 The highest-volume surgeon had a 9% fi stula rate and the lowest had a 42% rate.…”

Section: Resultsmentioning

confidence: 99%

Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis

et al. 2011

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The definitive surgical management of periampullary tumors is a challenging endeavor. This article reviews the available data on the efficacy of various methods of pancreaticoenteric reconstruction designed for the prevention of pancreatic fistula (PF). A literature search of the Medline database was used to identify randomized controlled trials (RCTs) that compared pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD). A total of two metaanalyses and four prospective RCTs were identified. Individual RCTs comparing PJ and PG allow the surgeons participating in the trial to choose technical modifications of one particular technique. As a result, there is no universal agreement as to whether one particular variation is safer and less prone to PF than the others. In addition, the majority of RCTs failed to stratify patient risk of PF. Further studies are therefore necessary to define the optimal technique of pancreatic reconstruction after PD conducted in high-volume centers by high-volume surgeons.

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“…3 Reported techniques cover a spectrum of complexity ranging from simple "parachuting" of the pancreatic stump into the jejunum to a more elaborate four-layer end-to-side ductal mucosa anastomosis. [8][9][10][11][12][13][14][15] We employ a binding method to seal the jejunum to the pancreatic stump rather than using multiple anchoring sutures. The results are very encouraging.…”

Section: Discussionmentioning

confidence: 99%

Binding pancreaticojejunostomy: 150 consecutive cases without leakage

Peng

2003

Journal of Gastrointestinal Surgery

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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.

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Pancreaticojejunostomy-securing technique: duct-to-mucosa anastomosis by continuous running suture and parachuting using monofilament absorbable thread

Cited by 20 publications

References 15 publications

Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy

Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy

Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis

Binding pancreaticojejunostomy: 150 consecutive cases without leakage

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