Pancreatic Anastomosis Healing


Background: Pancreatoduodenectomy (PD) is a complex procedure with a relatively high risk of complications. There is an increasing trend showing that the success of pancreato-enteral anastomosis depends on surgical skill and the material used. Methods: We present four cases of pancreato-enteral anastomosis resected 37 - 114 days after primary surgery and the analysis of the healing process, i.e., morphology of the pancreatic parenchyma, pancreatic duct, and digestive tract mucosa, as well as the pancreatic reaction to the sewing material by microscopic morphometry. Results: Evidence of regeneration in the columnar-lined mucosa of main pancreatic ducts in all cases of pancreato-enterostomy was observed. The inflammatory foreign-body reaction around monofilament stitch was present without an evident infection. There were no microscopic signs of pancreatic duct damage. Total foreign body reaction varied between 138.1 μm and 207.3 μm. Conclusions: This observation supports the beneficial use of thin monofilament threads for pancreato-enteral anastomosis. There was no evidence of harmful action from gastric or intestinal juices on pancreatic remnant or the Wirsung duct.

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S. Hac, R. Peksa, M. Dobosz, T. Wysocki, P. Lampe, K. Kusnierz, P. Mroczkowski and Z. Sledzinski, "Pancreatic Anastomosis Healing," Open Journal of Pathology, Vol. 2 No. 3, 2012, pp. 96-101. doi: 10.4236/ojpathology.2012.23018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Bassi, M. Falconi, E. Molinari, W. Mantovani, G. Butturini, A. A. Gumbs, R. Salvia and P. Pederzoli, “Duct-to-Mucosa versus End-to-Side Pancreaticojejunostomy Reconstruction after Pancreaticoduodenectomy: Results of a Prospective Randomized Trial,” Surgery, Vol. 134, No. 5, 2003, pp. 766-771. doi:10.1016/S0039-6060(03)00345-3
[2] A. Nakao, T. Fujii, H. Sugimoto, T. Kaneko, S. Takeda, S. Inoue, S. Nomoto and N. Kanazumi, “Is Pancreaticogastrostomy Safer than Pancreaticojejunostomy?” Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 13, No. 3, 2006, pp. 202-206. doi:10.1007/s00534-005-1034-8
[3] H. Shinchi, S. Takao, K. Maemura and T. Aikou, “A New Technique for Pancreaticogastrostomy for the Soft Pancreas: The Transfixing Suture Method,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 13, No. 3, 2006, pp. 212-217. doi:10.1007/s00534-005-1036-6
[4] K. Z’graggen, W. Uhl, H. Friess and W. M. Buchler, “How to Do a Safe Pancreatic Anastomosis,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 9, 2002, pp. 733-737. doi:10.1007/s005340200101
[5] J. Conze, K. Junge, U. Klinge, C. Weiss, M. Polivoda, A. P. Oettinger and V. Schumpelick, “Intraabdominal Adhesion Formation of Polypropylene Mesh. Influence of Coverage of Omentum and Polyglactin,” Surgical Endoscopy, Vol. 19, 2005, pp. 798-803. doi:10.1007/s00464-004-2192-5
[6] C. Niederau, R. A. Liddle, L. D. Ferrell and J. H. Grendell, “Beneficial Effects of Cholecystokinin-Receptor Blockade and Inhibition of Proteolytic Enzyme Activity in Experimental Acute Hemorrhagic Pancreatitis in Mice. Evidence for Cholecystokinin as a Major Factor in the Development of Acute Pancreatitis,” Journal of Clinical Investigation, Vol. 78, 1986, pp. 1056-1063. doi:10.1172/JCI112661
[7] J. M. Howard, “Development and Progress in Resective Surgery for Pancreatic Cancer,” World Journal of Surgery, Vol. 23, 1999, pp. 901-906. doi:10.1007/s002689900597
[8] N. T. van Heek, K. F. Kuhlmann, R. J. Scholten, S. M. de Castro, O. R. Busch, T. M. van Gulik, H. Obertop and D. J. Gouma, “Hospital Volume and Mortality after Pancreatic Resection: A Systematic Review and an Evaluation of Intervention in the Netherlands,” Annals of Surgery, Vol. 242, No. 4, 2005, pp. 781-788. doi:10.1097/01.sla.0000188462.00249.36
[9] A. Kleespies, M. Albertsmeier, F. Obeidat, H. Seeliger, K. W. Jauch and C. J. Bruns, “The Challenge of Pancreatic Anastomosis,” Langenbeck’s Archives of Surgery, Vol. 393, 2008, pp. 459-471. doi:10.1007/s00423-008-0324-4
[10] M. Hartel, M. N. Wente, S. P. Di, H. Friess and W. M. Buchler, “The Role of Extended Resection in Pancreatic Adenocarcinoma: Is There Good Evidence-Based Justification?” Pancreatology, Vol. 4, No. 6, 2004, pp. 561-566. doi:10.1159/000082181
[11] K. Hakamada, S. Narumi, Y. Toyoki, M. Nara, K. Ishido, T. Miura, N. Kubo and M. Sasaki, “An Easier Method for Performing a Pancreaticojejunostomy for the Soft Pancreas Using a Fast-Absorbable Suture,” World Journal of Gastroenterology, Vol. 14, No. 7, 2008, pp. 1091-1096. doi:10.3748/wjg.14.1091
[12] M. N. Wente, S. V. Shrikhande, M. W. Muller, M. K. Diener, C. M. Seiler, H. Friess and W. M. Buchler, “Pancreaticojejunostomy versus Pancreaticogastrostomy: Systematic Review and Meta-Analysis,” American Journal of Surgery, Vol. 193, No. 2, 2007, pp. 171-183. doi:10.1016/j.amjsurg.2006.10.010
[13] J. Laukkarinen, T. Lamsa, I. Nordback, J. Mikkonen and J. Sand, “A Novel Biodegradable Pancreatic Stent for Human Pancreatic Applications: A Preclinical Safety Study in a Large Animal Model,” Gastrointestinal Endoscopy, Vol. 67, No. 7, 2008, pp. 1106-1112. doi:10.1016/j.gie.2007.10.013
[14] I. Nordback, T. Lamsa, J. Laukkarinen, J. Leppiniemi, M. Kellomaki and J. Sand, “Pancreatico-Jejunostomy with a Biodegradable Pancreatic Stent and without Stitches through the Pancrea,” Hepatogastroenterology, Vol. 55, 2008, pp. 319-322.
[15] M. A. Muftuoglu, E. Ozkan and A. Saglam, “Effect of Human Pancreatic Juice and Bile on the Tensile Strength of Suture Materials,” American Journal of Surgery, Vol. 188, No. 2, 2004, pp. 200-203. doi:10.1016/j.amjsurg.2003.12.068
[16] K. N. Leknes, K. A. Selvig, O. E. Boe and U. M. Wikesjo, “Tissue Reactions to Sutures in the Presence and Absence of Anti-Infective Therapy,” Journal of Clinical Periodontology, Vol. 32, No. 2, 2005, pp. 130-138. doi:10.1111/j.1600-051X.2005.00647.x
[17] T. Lamsa, H. T. Jin, P. H. Nordback, J. Sand and I. Nordback, “Effects of Diameter, Number and Tightness of Sutures on Pancreatic Injury Response,” Digestive Surgery, Vol. 25, No. 4, 2008, pp. 269-277. doi:10.1159/000135604
[18] J. H. Nguyen, “Distinguishing between Parenchymal and Anastomotic Leakage at Duct-to-Mucosa Pancreatic Reconstruction in Pancreaticoduodenectomy,” World Journal of Gastroenterology, Vol. 14, No. 43, 2008, pp. 6648-6654. doi:10.3748/wjg.14.6648

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