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.