Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube.
نویسندگان
چکیده
BACKGROUND PURPOSE There is a high risk of anastomotic leakage after pancreaticojejunostomy following pancreaticoduodenectomy in patients with a normal soft pancreas because of the high degree of exocrine function. Therefore, pancreaticojejunostomy is generally performed using a stenting tube (stented method). However, pancreaticojejunostomy with a certain duct-to-mucosa anastomosis does not always require a stenting tube, even in patients with a normal soft pancreas. Recently, we have performed pancreaticojejunostomy with duct-to-mucosa anastomosis without a stenting tube (nonstented method) and obtained good results. METHODS The point of this technique is to maintain adequate patency of the anastomosis using a fine atraumatic needle and monofilament thread. The results of end-to-side pancreaticojejunostomy of the normal soft pancreas using the nonstented method (n = 123) were compared with those using the stented method (n = 45). RESULTS There were no differences in background characteristics between the groups, including age, gender, and disease. The mean times to complete pancreaticojejunostomy were around 30 min in the two groups and the rates of morbidity and leakage of pancreaticojejunostomy were 26.8% and 5.7% in the nonstented group and 22.2% and 6.7% in the stented group, respectively. These differences were not statistically significant. One patient in the stented group died of sepsis following leakage of pancreaticojejunostomy. There were also no significant differences in the mean time to initiation of solid food intake or postoperative hospital stay. CONCLUSIONS In conclusion, complete pancreaticojejunostomy using duct-to-mucosa anastomosis for a normal soft pancreas does not require a stenting tube. This nonstented method can be considered one of the basic procedures for pancreaticojejunostomy because of its safety and certainty.
منابع مشابه
In situ vs ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with billroth I-type reconstruction.
BACKGROUND Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, and an external stent of pancreaticojejunostomy has been recommended to prevent pancreatic fistula. HYPOTHESIS Duct-to-mucosa pancreaticojejunostomy should not require placement of an external stent. DESIGN Nonrandomized control study. SETTING University hospital. PATIENTS Seventy-...
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عنوان ژورنال:
- Journal of hepato-biliary-pancreatic surgery
دوره 13 3 شماره
صفحات -
تاریخ انتشار 2006