The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon's experience.
10.4174/astr.2015.89.2.61
- Author:
Hyung Jun KWON
1
;
Heon Tak HA
;
Young Yeun CHOI
;
Sang Geol KIM
Author Information
1. Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea. ksg@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Pancreaticojejunostomy;
Pancreatic fistula
- MeSH:
Arrhythmias, Cardiac;
Candida;
Cause of Death;
Humans;
Incidence;
Pancreatic Fistula*;
Pancreaticoduodenectomy;
Pancreaticojejunostomy*;
Sepsis;
Sutures
- From:Annals of Surgical Treatment and Research
2015;89(2):61-67
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call "inverted mattress PJ (IM)". The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF. METHODS: From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs. RESULTS: The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P < 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths. CONCLUSION: IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.
