Clinical Application Of U-suture Technique For End-to-side Invaginated Pancreaticojejunostomy

Objective:To explore the usefulness and effectiveness of a novel type of pancreatic intestinal anastomosis(U-suture technique for end-to-side invaginated pancreaticoje-junostomy)following pancreaticoduodenectomy.Methods:A total of 163 patients who had undergone pancreaticoduodenectomy at Yanbian University Hospital from September 2008 to September 2016 were retrospective analyzed.All patients were classified into three groups according to the method of pancreatic-enteric anastomosis:28 cases were performed with pancreatic duct to jejunum mucosa anastomosis(Group A),90 cases were received the no naked pancreatic surface in the cavity of jejunum pancreaticojejunostomy(Group B),and 45 cases were performed with U-suture technique for end-to-side invaginated pancreaticojejunostomy(Group C,include 1 cases on laparoscopic pancreaticoduode-nectomy).;Comparing the difference of several risk factors for pancreatic fistula,the incidence of major postoperative complications,the time of anastomosis and postoperative hospital stay among three groups.Relusts:Comparison of several risk factors for pancreatic fistula among the three groups,there were not significantly different.There was significant difference in the incidence of pancreatic fistula among the three groups(Group A:32.1%,Group B:3.3%,Group C:2.2%,P<0.001);The incidence of clinically relevant pancreatic fistulas(B ＋C grade)was statistically different among the three groups(Group A:17.9%,Group B:2.2%,Group C:0%,P<0.001):Compared with Group B,the incidence of clinically relevant pancreatic fistulas in Group A was significantly higher(P=0.008<0.0167);There was significant difference between Group A and Group C,Group C was lower than Group A(P=0.007<0.0167).While the difference between group B and group C was not statistically significant(P=0.552>0.0167).Other non-pancreatic fistula major complications(delayed gastric emptying,biliary fistula,etc.)among the three groups were no significant differences(P>0.05).The anastomosis time of pancreaticojejunos-tomy was significantly different in three groups.(Group A:29.1±2.6 min,Group B:25.1±2.6min,Group C 13.6±2.4min,P<0.001):The anastomosis time of Group A was longer than Group B and Group C(P<0.001),and Group B was significantly longer than Group C(P<0.001).There was not statistically difference in postoperative hospital stay among the three groups.Conclusions:This novel U-suture technique for end-to-side invaginated pancreaticoje-junostomy is safe and utilitarian,it can effectively reduce the incidence of clinically relevant pancreatic fistulas;The duration of anastomosis is short,easy to perform and master;This technique can be suitable for laparoscopic pancreaticojejunostomy.