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has been cited by the following article:

• TITLE: A Simple and Dependable Technique for Pancreatic-Enteric Anastomosis with a Soft Pancreas and Nondilated Duct

  AUTHORS: Daniel Vasilev Kostov, Georgi Leonidov Kobakov, Daniel Veselov Yankov, Kiril Georgiev Kirov

  KEYWORDS: Pancreaticoduodenectomy, Single Layer Pancreaticojejunostomy, Soft Pancreas, Nondilated Duct, Pancreatic Anastomotic Leak

  JOURNAL NAME: Surgical Science, Vol.5 No.10, October 22, 2014

  ABSTRACT: Background:Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy(PD).The most significantriskfactorsforpancreatic leakage are pancreatic texture,main pancreatic duct (MPD)size and anastomotic technique. Herewith we describeourtechnical modifications forsingle-layerpancreaticojejunostomy (PJ) with a soft pancreas and nondilatedMPDfor reconstructionafterPD.Methods: We report our early experience using this technique in 52 patients who underwent PD between May 2009andDecember2012.Results:Overall postoperative mortality rate was1.92%.Postoperative morbidity rate was 32.69%, withmajor complications occurring inthreepatients (5.77%).Pancreatic leak wasdiagnosedin sixpatients (11.54%). Threepatients withpancreatic fistulae (PF)of Grades A and B weremanaged conservatively, whereasthreeotherpatients with PFofGradeC required relaparotomy.Conclusions:According to our early experience with thismodified technique for PJ,usage ofhorizontal mattresssutures, “everting”of MPD and incorporation of its wall into asingle layer pancreatic-enteric anastomosisresult in a low pancreatic anastomotic leakagerateafterPD. This technique for PJwith a soft pancreas and nondilated ductensures idealpreconditions for anastomosis healing. They consist ofan excellent blood supply, an anatomicalposition with tension-free approximation and unobstructedpancreatic juice flow from the pancreas into the jejunalloop.