Efficacy analysis of double-“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic leakage / 中华消化外科杂志

Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

Preliminary results of binding pancreaticojejunostomy

BACKGROUNDS/AIMS: The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng. METHODS: We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines. RESULTS: Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management. CONCLUSIONS: The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

Efficacy of simplified binding pancreaticojejunostomy / 中华消化外科杂志

Objective To investigate the methods and techniques of simplified binding pancreaticojejunostomy for patients with periampullary malignant tumor after radical pancreatoduodenectomy (RPD). Methods From March 2005 to May 2010, 323 patients with periampullary malignant tumor received RPD at the Tongji Hospital of Huazhong University of Science and Technology, and their clinical data were retrospectively analyzed.Simplified binding pancreaticojejunostomy was applied after RPD: the distal end of pancreas was freed for 3-4 cm;a No. 6 or No. 8 silicone urinary catheter was inserted into the pancreatic duct for 4-5 cm, and the remaining urinary catheter (6-8 cm) out of the pancreatic duct was sutured to the pancreatic stump with absorbable sutures.The cutting end of the jejunum (2-3 cm) was everted, and the everted mucosa of the jejunum ( 1 cm) was injured by electrocautery, then the everted jejunum was reverted to its normal position. The cutting end of the mesentery of jejunum and its opposite side, as well as the mid-point of these two parts were sutured symmetrically with the lower and upper edges of the pancreas, and with the capsule of pancreas between them. The everted jejunum was wrapped over the pancreatic stump and sutured it to the pancreas for fixation. The cutting end of the jejunum was bound to the pancreatic stump with 1-0 absorbable suture after confirming the jejunum was completely invaginated into the pancreas. The alimentary tract was reconstructed by using Child's method. Results Simplified binding pancreaticojejunostomy was successfully completed in all patients, Pancreatic fistula was detected in one patient who was complicated with anastomotic bleeding on the third day after secondary laparotomy. The patient was discharged with catheter and spontaneously recovered one month later. Pancreatic fistula was also detected in two patients with distal bile duct carcinoma and two patients with carcinoma in the uncinate process of pancreas at postoperative day 3, 6, 8 and 11, and they were cured by expectant treatment. The incidence of pancreatic fistula was 1.5% (5/323). Conclusion Simplified binding pancreaticojejunostomy is simple, safe and feasible, and it can significantly reduce the incidence of pancreatic fistula.

Binding Pancreaticojejunostomy Compared with Dunking Pancreaticojejunostomy

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.

Binding Pancreaticojejunostomy Compared with Dunking Pancreaticojejunostomy

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.

The Effect of Binding Pancreaticojejunostomy on Prevention of Pancreatic Leakage after Pancreaticoduodenectomy / 中国医师杂志

Objective To investigate the effect of binding pancreaticojejunostomy (BPJ) on the prevention of the pancreatic leakage after pancreaticoduodenectomy(PD). Methods The clinical data of 108 patients who underwent PD, including 26 cases of BPJ since 2001 and 82 cases of other type of pancreaticojejunostomy from 1993 to 2000,were retrospectively analyzed. Results The frequency of pancreatic leakage in this series was 13.9%. No pancreatic leakage occurred in BPJ group, whereas the frequency of pancreatic leakage in end-to-end invaginated pancreaticojejunostomy group and duct-to-mucosa pancreaticojejunostomy group was 24.6%(14/57) and 4.0%(1/25),respectively. The frequency of pancreatic leakage in BPJ group was significantly lower than that in end-to-end invaginated pancreaticojejunostomy group(P0.05). Conclusion BPJ may be effective in the prevention of the pancreatic leakage after PD.