Brief Article
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World J Gastroenterol. Jul 21, 2013; 19(27): 4351-4355
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4351
A new pancreaticojejunostomy technique: A battle against postoperative pancreatic fistula
Stylianos Katsaragakis, Andreas Larentzakis, Sotirios-Georgios Panousopoulos, Konstantinos G Toutouzas, Dimitrios Theodorou, Spyridon Stergiopoulos, Georgios Androulakis
Stylianos Katsaragakis, Andreas Larentzakis, Sotirios-Georgios Panousopoulos, Konstantinos G Toutouzas, Dimitrios Theodorou, Spyridon Stergiopoulos, Georgios Androulakis, 1st Department of Propaedeutic Surgery, Athens Medical School, Hippocratio Athens General Hospital, University of Athens, 11527 Attiki, Greece
Author contributions: Katsaragakis S conceived the idea, revised the manuscript and performed the majority of the procedures; Larentzakis A, Panousopoulos SG and Toutouzas KG assisted in the majority of the performed procedures and made a substantial contribution to the design, data acquisition and interpretation, as well as to the manuscript drafting and writing; Theodorou D, Stergiolpoulos S and Androulakis G contributed to the data analysis and revision of the manuscript; all the authors gave their final approval of the version to be published.
Correspondence to: Andreas Larentzakis, MD, PhD, 1st Department of Propaedeutic Surgery, Athens Medical School, Hippocratio Athens General Hospital, University of Athens, No 11, 3rd September 1843 str., Egaleo, 11527 Athens, Greece. alarentz@med.uoa.gr
Telephone: +30-210-5909561 Fax: +30-210-5909561
Received: January 23, 2013
Revised: April 23, 2013
Accepted: May 8, 2013
Published online: July 21, 2013
Processing time: 178 Days and 1.7 Hours
Abstract

AIM: To present a new technique of end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and insertion of a silicone stent.

METHODS: We present an end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and the insertion of a silicone stent. This technique was performed in thirty-two consecutive patients who underwent a pancreaticoduodenectomy procedure by the same surgical team, from January 2005 to March 2011. The surgical procedure performed in all cases was classic pancreaticoduodenectomy, without preservation of the pylorus. The diagnosis of pancreatic leakage was defined as a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase concentration greater than three times the serum amylase activity.

RESULTS: There were 32 patients who underwent end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation. Thirteen of them were women and 19 were men. These data correspond to 40.6% and 59.4%, respectively. The mean age was 64.2 years, ranging from 55 to 82 years. The mean operative time was 310.2 ± 40.0 min, and was defined as the time period from the intubation up to the extubation of the patient. Also, the mean time needed to perform the pancreaticojejunostomy was 22.7 min, ranging from 18 to 25 min. Postoperatively, one patient developed a low output pancreatic fistula, three patients developed surgical site infection, and one patient developed pneumonia. The rate of overall morbidity was 15.6%. There was no 30-d postoperative mortality.

CONCLUSION: This modification appears to be a significantly safe approach to the pancreaticojejunostomy without adversely affecting operative time.

Keywords: Whipple; Pancreaticojejunostomy; Technique; Seromuscular jejunal flap; Pancreatic fistula

Core tip: Pancreaticojejunostomy represents one of the most challenging technical aspects of the Whipple procedure, mainly due to its failure, and to the resulting morbidity and mortality rates. Several technical variations have been proposed, in an effort to minimize postoperative pancreatic fistula rates. The technique we describe is an end-to-side, duct-to-mucosa two-layer pancreaticojejunostomy intended to promote enhanced healing process, through the creation of a seromuscular jejunal flap. This technique appears to be safe and reliable; however, these are preliminary results.