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"True" duct-to-mucosa pancreaticojejunostomy, with secure eversion of the enteric mucosa, in Whipple operation.
- Source :
-
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2015 Mar; Vol. 19 (3), pp. 498-505. Date of Electronic Publication: 2014 Dec 04. - Publication Year :
- 2015
-
Abstract
- Background: Postoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call "true" duct-to-mucosa anastomosis (DMA)-pancreaticojejunostomy.<br />Methods: A novel enteric mucosal eversion at the point of the jejunostomy is constructed prior to the anastomosis with the pancreatic duct in order to enhance sealing. This technique was tested in a series of 38 patients (study group) and compared to the technique used in the preceding 35 patients who served as controls.<br />Results: The incidence of POPF was significantly lower in the study group compared to controls: 7.9 % (3/38) vs 34.3 % (12/35), respectively (P = 0.008, odds ratio 6.1). All POPFs in the study group were International Study Group on Pancreatic Fistula (ISGPF) grade A, while in the control group POPFs ISGPF grade B and C occurred in 17.1 %. Additionally, median (interquartile range) postoperative hospitalization was reduced in the study group [16 (14-21) days] compared to controls [20 (16-27) days, P = 0.005].<br />Conclusions: The "true" DMA technique appears to be one of the safest techniques reported to date. The modifications presented herein can easily be adopted by experienced surgeons already performing other techniques of duct-to-mucosa anastomosis.
- Subjects :
- Adult
Aged
Anastomotic Leak epidemiology
Female
Historically Controlled Study
Humans
Incidence
Male
Middle Aged
Pancreatic Fistula epidemiology
Retrospective Studies
Treatment Outcome
Anastomotic Leak surgery
Intestinal Mucosa surgery
Pancreatic Ducts surgery
Pancreatic Fistula surgery
Pancreaticoduodenectomy
Pancreaticojejunostomy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1873-4626
- Volume :
- 19
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
- Publication Type :
- Academic Journal
- Accession number :
- 25472029
- Full Text :
- https://doi.org/10.1007/s11605-014-2709-8