Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2731-2738
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2731
Continuous suture of the pancreatic stump and Braun enteroenterostomy in pancreaticoduodenectomy
Hong-Bo Meng, Bo Zhou, Fan Wu, Jie Xu, Zhen-Shun Song, Jian Gong, Mahbuba Khondaker, Bin Xu
Hong-Bo Meng, Bo Zhou, Zhen-Shun Song, Jian Gong, Bin Xu, Department of General Surgery, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
Fan Wu, Department of Obstetrics and Gynecology, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
Jie Xu, GI Division, Renji Hospital, Shanghai Institute of Digestive Diseases, Shanghai Jiao-Tong University School of Medicine, Shanghai 200127, China
Mahbuba Khondaker, Tongji University School of Medicine, Shanghai 200072, China
Author contributions: Meng HB and Zhou B contributed equally to this work; Meng HB and Xu B designed the research; Meng HB, Zhou B, Wu F, Xu J, Song ZS, Gong J and Xu B performed the research; Meng HB, Wu F, Khondaker M and Xu B analyzed the data; Meng GB, Khondaker M and Xu B wrote the paper.
Supported by National Natural Science Foundation of China, No. 81001007; and the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry.
Ethics approval: The study was reviewed and approved by Shanghai 10th People’s Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardians, provided informed written consent prior to study enrollment. Informed consent concerning partial data used in analysis was not obtained from the participants, because the data were analyzed anonymously.
Conflict-of-interest: No potential conflicts of interest relevant to this article are reported.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Xu, MD, Department of General Surgery, Shanghai 10th People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China. pfdbsxubin@163.com
Telephone: +86-21-66307384 Fax: +86-21-66301051
Received: October 9, 2014
Peer-review started: October 10, 2014
First decision: October 29, 2014
Revised: November 19, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: March 7, 2015
Processing time: 150 Days and 17.2 Hours
Abstract

AIM: To investigate a new modification of pancreaticoduodenectomy (PD)-a mesh-like running suturing of the pancreatic remnant and Braun’s enteroenterostomy.

METHODS: Two hundred and three patients underwent PD from 2009 to 2014 and were classified into two groups: Group A (98 patients), who received PD with a mesh-like running suturing for the pancreatic remnant, and Braun’s enteroenterostomy; and Group B (105 patients), who received standard PD. Demographic data, intraoperative findings, postoperative morbidity and perioperative mortality between the two groups were compared by univariate and multivariate analysis.

RESULTS: Demographic characteristics between Group A and Group B were comparable. There were no significant differences between the two groups concerning perioperative mortality, and operative blood loss, as well as the incidence of the postoperative morbidity, including reoperation, bile leakage, intra-abdominal fluid collection or infection, and postoperative bleeding. Clinically relevant postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) were identified more frequently in Group B than in Group A. Technique A (PD with a mesh-like running suturing of the pancreatic remnant and Braun’s enteroenterostomy) was independently associated with decreased clinically relevant POPF and DGE, with an odds ratio of 0.266 (95%CI: 0.109-0.654, P = 0.004) for clinically relevant POPF and 0.073 (95%CI: 0.010-0.578, P = 0.013) for clinically relevant DGE.

CONCLUSION: An additional mesh-like running suturing of the pancreatic remnant and Braun’s enteroenterostomy during PD decreases the incidence of postoperative complications and is beneficial for patients.

Keywords: Pancreaticoduodenectomy; Delayed gastric emptying; Braun’s enteroenterostomy; Running suture; Postoperative pancreatic fistula

Core tip: How to reduce postoperative morbidity after pancreaticoduodenectomy (PD) is a pressing problem. A new modification of PD, mesh-like running suturing of the pancreatic remnant and an additional Braun’s enteroenterostomy, was performed in our center. The procedure significantly reduced the postoperative complications, including pancreatic fistula and clinically relevant delayed gastric emptying. These surgical techniques are safe and effective, and are easily mastered by surgeons, which improves outcomes of PD and offers major economic and social benefits.