Background:?Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy?(PD).?The most significant?riskfactors?for?pancreatic leakage are pancreatic texture,?main pancre...Background:?Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy?(PD).?The most significant?riskfactors?for?pancreatic leakage are pancreatic texture,?main pancreatic duct (MPD)?size and anastomotic technique. Herewith we describe?our?technical modifications for?single-layer?pancreaticojejunostomy (PJ) with a soft pancreas and nondilated?MPD?for reconstruction?after?PD.?Methods: We report our early experience using this technique in 52 patients who underwent PD between May 2009?and?December?2012.?Results:?Overall postoperative mortality rate was1.92%.?Postoperative morbidity rate was 32.69%, with?major complications occurring in?three?patients (5.77%).?Pancreatic leak was?diagnosed?in sixpatients (11.54%). Three?patients with?pancreatic fistulae (PF)?of Grades A and B were?managed conservatively, whereas?three?other?patients with PF?of?Grade?C required relaparotomy.?Conclusions:?According to our early experience with this?modified technique for PJ,?usage of?horizontal mattress?sutures, “everting”?of MPD and incorporation of its wall into a?single layer pancreatic-enteric anastomosis?result in a low pancreatic anastomotic leakagerate?after?PD. This technique for PJ?with a soft pancreas and nondilated ductensures ideal?preconditions for anastomosis healing. They consist of?an excellent blood supply, an anatomical?position with tension-free approximation and unobstructed?pancreatic juice flow from the pancreas into the jejunal?loop.展开更多
文摘Background:?Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy?(PD).?The most significant?riskfactors?for?pancreatic leakage are pancreatic texture,?main pancreatic duct (MPD)?size and anastomotic technique. Herewith we describe?our?technical modifications for?single-layer?pancreaticojejunostomy (PJ) with a soft pancreas and nondilated?MPD?for reconstruction?after?PD.?Methods: We report our early experience using this technique in 52 patients who underwent PD between May 2009?and?December?2012.?Results:?Overall postoperative mortality rate was1.92%.?Postoperative morbidity rate was 32.69%, with?major complications occurring in?three?patients (5.77%).?Pancreatic leak was?diagnosed?in sixpatients (11.54%). Three?patients with?pancreatic fistulae (PF)?of Grades A and B were?managed conservatively, whereas?three?other?patients with PF?of?Grade?C required relaparotomy.?Conclusions:?According to our early experience with this?modified technique for PJ,?usage of?horizontal mattress?sutures, “everting”?of MPD and incorporation of its wall into a?single layer pancreatic-enteric anastomosis?result in a low pancreatic anastomotic leakagerate?after?PD. This technique for PJ?with a soft pancreas and nondilated ductensures ideal?preconditions for anastomosis healing. They consist of?an excellent blood supply, an anatomical?position with tension-free approximation and unobstructed?pancreatic juice flow from the pancreas into the jejunal?loop.
