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. 2009 Mar;11(2):154-60.
doi: 10.1111/j.1477-2574.2009.00028.x.

Modified Cattell's pancreaticojejunostomy, buttressing for soft pancreases and an isolated biliopancreatic loop are safety measurements that improve outcome after pancreaticoduodenectomy: a pilot study

Mohammed Abu Hilal  1 , Hassan Z Malik, Werebena Hamilton-Burke, Caroline Verbeke, Krishna V Menon
Affiliations

Modified Cattell's pancreaticojejunostomy, buttressing for soft pancreases and an isolated biliopancreatic loop are safety measurements that improve outcome after pancreaticoduodenectomy: a pilot study

Mohammed Abu Hilal et al. HPB (Oxford). 2009 Mar.

Abstract

Background: Pancreatic anastomotic leak is one of the most serious complications following pancreaticoduodenectomy (PD). Various factors have been implicated as contributors to pancreatic anastomotic leaks, the incidence of which has been as high as 28% in some series.

Objectives: We describe technical modifications to Cattell's technique for pancreaticojejunostomy (PJ), with buttressing of 'soft' pancreases and use of an isolated biliopancreatic loop for reconstruction following a PD.

Methods: We report our early experience using this technique in 50 patients who underwent PD between May 2002 and June 2006.

Results: There was no mortality in our series. The postoperative morbidity rate was 32% (16/50), with major complications occurring in seven (14%) patients. Pancreatic leak occurred in one patient (2%) and bile leak in one patient (2%). Both patients were managed conservatively.

Conclusions: Reconstruction after PD using an isolated biliopancreatic loop and modifications to Cattell's technique for PJ, with buttressing of the soft pancreas, can be performed with a low risk of pancreatic anastomotic leakage.

Keywords: Cattell; Pancreaticoduodenectomy; buttressing; pancreaticojejunostomy; seromyotomy.

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Figures

Figure 1
Figure 1
Isolated biliopancreatic loop
Figure 3
Figure 3
Jejunal seromyotomy (pancreaticojejunostomy technique)
Figure 2
Figure 2
Buttressing of pancreas 4/0 PDS sutures (pancreaticojejunostomy technique)
Figure 6
Figure 6
Anterior layer using interrupted 4/0 PDS sutures (pancreaticojejunostomy technique)
Figure 5
Figure 5
Duct-to-mucosa with single-layer 5/0 or 6/0 PDS sutures (pancreaticojejunostomy technique)
Figure 4
Figure 4
Posterior layer using interrupted 4/0 PDS sutures, with metal probe in duct (pancreaticojejunostomy technique)
See this image and copyright information in PMC

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