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- Title
Proposal for a Safe and Functional Pancreaticojejunostomy Technique from a Histopathological Perspective.
- Authors
Mitsuyoshi, Akira; Hamada, Shinshichi; Ohe, Hidenori; Fujita, Haruku; Okabe, Hiroshi; Inoguchi, Kenta
- Abstract
Background: To prevent leakage of pancreatic juice from the main pancreatic duct (MPD), complete external drainage appears to be the most effective technique. However, because this requires a pancreatic stent tube to be ligated with MPD, duct-to-mucosa pancreaticojejunostomy (PJ) is difficult. From our histopathological examination, a large amount of pancreatic juice is drained from the ducts other than MPD. This study aimed to evaluate our new conceptual technique of PJ after pancreaticoduodenectomy (PD).Methods: We considered it important to drain pancreatic juice from the branch pancreatic ducts to the intestinal tract and to perform duct-to-mucosa PJ, while pancreatic juice from MPD is completely drained out of the body. We designed a technique that could simultaneously achieve these points. In our technique, which is based on conventional “two-row” anastomosis, a stent tube is fixed with MPD and its surrounding tissue by purse-string suture at the cut surface of the pancreas, and duct-to-mucosa PJ is concomitantly performed.Results: Of 45 patients undergoing PD, 12 of soft pancreas underwent surgery with this technique. According to the classification of the International Study Group on Pancreatic Fistula, a Grade A PF was observed in four patients, whereas no patient had a Grade B or C PF.Conclusions: We propose our anastomotic technique that could simultaneously prevent PF and keep the pancreatic duct patent.
- Subjects
PANCREATIC secretions; PANCREATICODUODENECTOMY; FISTULA; DUODENECTOMY; PANCREATECTOMY
- Publication
World Journal of Surgery, 2018, Vol 42, Issue 12, p4090
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-018-4718-3