Potential New Method of Pancreaticojejunostomy

A new method of pancreaticojejunostomy using a fast-absorbable suture material and a temporary stent tube could overcome the technical difficulties involved in performing a pancreaticoenterostomy of a soft pancreas with a narrow pancreatic duct.

Researchers from Hirosaki University (Aomori, Japan) examined 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy between 2003 and 2006. Thirty-five of these patients were treated with a new reconstructive method, and the initial surgical results were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis. After the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated to it by a fast-absorbable irradiated polyglactin 910 suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum.

The initial surgical results showed that incidences of postoperative morbidity, including pancreatic fistula, were comparable between the two groups. There was no mortality and re-admission, and late complications were rarely seen. Using the new technique, complete external drainage of the pancreatic juice was secured for about 2 weeks by approximating the pancreatic duct and the jejunal mucosa with the fast-absorbable suture. The researchers claimed that the good early and late outcomes of the simple and easy-to-perform method seem to justify the carrying out of a randomized prospective study to compare it with appropriate controls. The study was published in the February 21, 2008, issue of the World Journal of Gastroenterology.

"A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas,” concluded lead author Dr. Kenichi Hakamada, M.D., and colleagues of the department of gastroenterological surgery.

Leakage of the pancreaticoenterostomy remains a major cause of postoperative morbidity and mortality after pancreaticoduodenectomy. Many factors have been identified that are associated with an increased incidence of this complication. Among them, a soft pancreatic texture with a narrow pancreatic ductal size creates a high risk for the development of a pancreatic fistula, often leading to death.


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Hirosaki University