Application Of Duct-to-mucosa Continuous Anastomosis In The Pancreaticojejunostomy

Objective: Pancreatoduodenectomy(PD), for the treatment of pancreatic head, bile duct and duodenal ends, periampullary and other benign and malignant diseases, which involve surgical organ and more complex operation,technical difficulty at present. In spite of the improvement of surgical operation and care, the surgical mortality rate has dropped to about 5 percent,however, the incidence of postoperative complications is still around 40%.Wherein pancreatic fistula(pancreatic fistula, PF) is one of the most common complication, and its occurrence rate of 2% to 20%. This study was to explore a method of pancreaticojejunostomy in pancreaticoduodenectomy.Methods: Clinical data from June 2013 to June 2015 of 165 pancreaticoduodenectomy resection patients were retrospectively analyzed, at the Fourth Hospital of Hebei Medical University, Hepatobiliary Surgery. Of the patients, 53 patients with Prolene line continuous duct-to-mucosa, and 112 patients with end-to-side of pancreatic anastomosis were used. Diagnostic criteria referenced the International pancreatic fistula Study Group(ISGPF)defined in 2005. Statistical analysis was performed with the χ2 test. A probability value of less than 0.05 was considered statistically significant..Results: 69 cases in 165 consecutive PDs had complications(41.8%),such as abdominal infection(n = 36, morbidity = 21.8%), pancreatic fistula(n=19, morbidity =11.5%), gastrointestinal bleeding(n=17, morbidity=10.3%);and in operation 2 cases died(mortality =1.2%). The incidence of pancreatic fistulas in patients with prolene line continuous suture was 3.8%(2/53), and in those with end-to-side suture it was 15.2%(17/112)(P<0.05). According to the international clinical grading system, grade A of POPF was found in 2patients of the prolene line continuous suture group, and were successfully discharged under the conservative treatment.Conclusion: This method of duct-to-mucosa anastomosis with Prolene line continuous suturing is simple and time-saving with obviously reducing incidence of pancreatic fistula.It’s continuous anastomosis of main pancreatic duct and the whole jejunum layer, exactly, not easy to occur pancreatic fistula,less affected by the pancreas texture.The Prolene thread and Needle as a whole,lines of smooth, less friction, is suitable for continuous anastomosis. This method of anastomosis is proved to be safe and efficient in preventing pancreatic fistula.