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

We present a 45-year-old man with chronic pancreatitis and the rare complication of large subcapsular splenic pseudocyst. He suffered from a slow growing left upper quadrant abdominal distension for 2 weeks and pain radiating to his back. On abdominal computed tomography, large subcapsular splenic pseudocyst (25x13x11 cm), multiple small sized pancreatic pseudocysts in the pancreas tail and chronic pancreatitis with multiple pancreatic stones were shown. He underwent percutaneous catheter drainage of the splenic pseudocyst and after 3 weeks, the size of the pseudocyst decreased. But, the pain radiating to his back and poor oral intake was not improved. Distal pancreatectomy, Roux-en-Y pancreaticojejunostomy, and splenectomy were performed and the patient was discharged after 2 weeks. A splenic subcapsular pseudocyst resulting from pancreatitis may be managed by percutaneous drainage, but according to a patient's clinical symptoms, operative management can be added.
Catheters ; Drainage ; Humans ; Middle Aged ; Pancreas ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreaticojejunostomy ; Pancreatitis ; Pancreatitis, Chronic ; Spleen ; Splenectomy

PURPOSE: After performing pylous-preserving pancreaticoduodenectomy, there are several methods of performing pancreaticojejunostomy for preventing pancreatic leakage. The purpose of this study was to compare the results of two methods of jejunal anastomosis after pancreaticojejunostomy. METHODS: We retrospectively evaluated the clinical results of 49 patients who had received pancreaticojejunostomy for pylous-preserving pancreaticoduodenectomy. One method is the Billroth-I type, that is, choledochojejunostomy and pancreaticojejunostomy after anastomosis of one jejunum loop to the duodenum. The other method is the Roux-En-Y (R-Y) type. Choledochojejunostomy and pancreaticojejunostomy are done with an isolated jejunum loop. Then gastrojejunostomy is fashioned between the stomach and the distal jejunal segment. Finally, the end-to-side jejunojejunostomy is created. RESULTS: The Billroth-I type was used in 17 patients and the R-Y type was used in 32 patients. The median operation time was 397 min and 431 min, respectively. The median postoperative hospital day was 27.6 days and 22.1 days, respectively. The postoperative complications were 10 cases in 17 patients (58.8%) and 11 cases in 32 patients (34.4%), respectively. Leakage of the pancreaticojejunostomy was the most common complication in each group (23.5% and 15.6%, respectively). Most complications required no need surgical intervention. But two cases of Billroth-I type complications needed total pancreatectomy because of leakage of the pancreaticojejunostomy. CONCLUSION: Not only were there fewer complications for the R-Y type than for the Billroth-I type, but there was no need for operation to treat the complications of the R-Y type because of the isolated jejunal loop.
Choledochostomy ; Duodenum ; Gastric Bypass ; Humans ; Jejunum ; Pancreatectomy ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Postoperative Complications ; Retrospective Studies ; Stomach