No abstract available.
Pancreaticojejunostomy*

No abstract available.
Pancreaticoduodenectomy* ; Pancreaticojejunostomy*

The study was performed in 22 patients with pancreatic stones treated at Surgical Department of Bach Mai Hospital from May 1996 to July 2001. The study was to describe the clinical and paraclinical symptoms as well as the early outcome of wirsungotomy removing the calculi and pancreatico – jejunostomy. The result showed that the disease was more often seen in working ages; more male than females; clinical symptoms were not specific; diagnosis relied mainly on imagery examens. The pancreatolithotomy is effective operation and easy for patients and riquires futher surverying for long term evaluation.
Pancreatic Ducts ; Surgery ; Pancreaticojejunostomy ; Calculi

Pancreaticojejunostomy (PJ-stomy) is one of the most common types of reconstructive surgical techniques utilized after a pnacreaticoduodenectomy (PD), but there are several ways to perform this procedure. The leakage of the PJ-stomy is recognized as an important complication that may lead to mortality. Recently, the use of a dunking PJ-stomy has been advocated in a modified fashion after PD. We have successfully used a one-layer interrupted snuggly end-toend PJ-stomy (modified dunking PJ-stomy) with a temporary transjejunal pancreatic stent technique for 30 consecutive PDs between January 2003 and December 2005. All of the patients received the modified dunking PJ-stomy, regardless of the characteristics of the pancreas stump (soft or hard, dilated or nondilated pancreatic duct). Four patients presented with post operative complications (morbidity, 13.3%). Only two patients (6.7%) developed a PJ-stomy dehiscence that healed with adequate drainage treatment. We observed a reduction in dehiscence of pancreaticojejunal anastomosis with the use of the modified dunking PJ-stomy, and no postoperative mortality. In conclusion, we have developed a simple, snug anastomosis method and most importantly it has proved to be safe regardless of the characteristics of the pancreas stump.
Drainage ; Humans ; Mortality ; Pancreas ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stents

Stenosis of the pancreatico-enteric anastomosis is one of the major complications of pancreaticoduodenectomy (PD). Endoscopic stent placement, has limited success rate as a nonsurgical treatment due to altered gastrointestinal anatomy. Percutaneous treatment is rarely attempted due to the technical difficulty in accessing the pancreatic duct. We reported a case of pancreaticojejunostomy stenosis after PD, in which a pancreatic stent was successfully placed using a rendezvous technique with a dual percutaneous approach.
Constriction, Pathologic* ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stents*

PURPOSE: In this study, we introduced a novel technique, the pancreaticojejunostomy (PJ), which uses only two transpancreatic sutures with buttresses (PJt), and compared the surgical outcomes with previously used methods, especially for hard pancreases. METHODS: A total of 101 patients who underwent pancreaticoduodenectomy with hard pancreases were enrolled and divided into 3 groups according to the method of pancreaticoenteric anastomosis: 30 patients (29.7%) underwent the conventional dunking method (Du), 31 patients (30.7%) underwent pancreaticogastrostomy using transpancreatic sutures (PGt) and 40 patients (39.6%) underwent PJ using transpancreatic sutures (PJt). The surgical outcomes were compared according to the type of anastomosis to analyze the feasibility and ease of each technique. RESULTS: The overall operative time was shorter in the PJt group (325.1 +/- 63.8 minutes) than in the PGt group (367.3 +/- 70.5 minutes) or the Du group (412.0 +/- 38.2 minutes, P < 0.001). In terms of pancreaticoenteric anastomosis time, it was also shorter in the PJt group (10.3 +/- 3.5 minutes) than in the Du group (20.7 +/- 0.7 minutes) or the PGt group (16.8 +/- 5.4 minutes, P = 0.005). Significant postoperative pancreatic fistula (POPF) developed in 2 cases (6.7%) in the Du group, whereas there were no POPF cases in the PGt or PJt groups (P = 0.086). Overall postoperative morbidities occurred in 31 cases (30.7%), and there were no significant differences among the 3 groups (P = 0.692). CONCLUSION: The novel PJ technique, which uses only two transpancreatic sutures with buttresses, is a very simple, easy and secure method for hard pancreases and can be performed in a shorter amount of time compared with conventional methods.
Humans ; Methods* ; Operative Time ; Pancreas* ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Sutures*

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.
Amylases ; Humans ; Male ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Retrospective Studies

Pancreatic enteric anastomosis is an important step during pancreaticoduodenectomy. Based on the anastomosis site, pancreatic enteric anastomosis is classified as pancreaticojejunostomy anastomosis and pancreaticogastrostomy. Depending on the jejunum site, reconstruction can be perform as end-to-end or end-to-side anastomosis. Previous randomized clinical trials, showed no significant differences between pancreaticojejunostomy and pancreaticogastrostomy. Binding pancreaticojejunostomy and binding pancreaticogastrostomy are easy to perform. The rate of pancreatic leakage is related to the texture of the pancreas and the size of the pancreatic duct. It is helpful to reduce pancreatic leakage by placing a pancreatic duct stent. The simple and effective pancreatic enteric reconstruction is the future direction for minimizing leakage.
Humans ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; methods

PURPOSE: We wanted to evaluate the feasibility of using the suction pancreatic duct stent, which was designed to aspirate pancreatic fluid more actively around the pancreaticojejnostomy site during performance of pancreaticoduodenectomy for preventing pancreatic fistula. METHODS: In 7 consecutive pancreaticoduodenectomy patients, we inserted a PVC tube into the remnant pancreatic duct across the duct-to-mucosa type pancreaticojejunostomy at a 2 cm depth as a totally external pancreatic stent. This stent was connected with the aspiration bag of a Jackson- Pratt drain for generating negative pressure. We inserted another Jackson-Pratt drain beneath the pancreaticojejunosomy site and checked the amylase level in the body fluid and the serum at the postoperative 1st and 5th days for evaluating pancreatic leakage. We also checked the daily amount of pancreatic fluid obtained through the suction stent. Pancreatic fistula was defined as an amylase level in the body fluid >10,000 U/L on postoperative 1 day or an amylase level in the body fluid >3 times the serum amylase level on the postoperative 5th day. RESULTS: On postoperative day 1, the mean level of intraabdominal fluid amylase was 1,404 U/L (355~3,850 U/L). On the postoperative 5th day, the mean level of amylase in the body fluid was 40.3 U/L (12~144 U/L) and the mean level of serum amylase was 38.3 U/L (19~71 U/L). Even on the postoperative 1st day, we could collect a considerable amount of pancreatic fluid (mean: 55.6 ml (range: 9~169 ml)). There was no complication associated with pancreatic leakage. CONCLUSION: The suction pancreatic stent can be a feasible method to prevent pancreatic leakage. Additional randomized studies to compare the conventional pancreatic duct stent with the suction pancreatic duct stent are mandatory.
Amylases ; Body Fluids ; Humans ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stents* ; Suction*

Treatment of chronic pancreatitis (CP) is a challenging disease for surgeons. During the last several decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and development of sophisticated diagnostic methods in clinical practice have resulted in significant changes in surgery for CP. Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy and pathophysiology, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. Even though available results from randomized controlled trials were published, new studies are needed to determine which procedure is the most effective for the management of patients with CP.
Drainage ; Duodenum ; Head ; Humans ; Pain, Intractable ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; Quality of Life