Continuous suturing with two anterior layers reduces post-operative complications and hospitalization time in pancreaticoenterostomy

Abstract

Background: Most complications after pancreaticoduodenectomy (PD) were relation to pancreaticoenterostomy. We improved a new method of pancreaticoenterostomy that included the continuous suturing of the jejunum and the stump of the pancreas end-to-side with one layer posteriorly and two layers anteriorly. To evaluate the safety and efficiency of this new method, we introduced this retrospectively compared trial.

Methods: We compared 45 patients who had undergone pancreaticoduodenectomy with either the regular interrupted suturing method or the new continuous mattress suturing method in our hospital from September 2011 to March 2014.

Results: Although the total operation times were not reduced, the suturing time for the pancreaticoenterostomies in the continuous suture group (11.3 ± 1.8 min) was greatly reduced compared with that for the interrupted suture group (14.1 ± 2.9 min, p = 0.045). Importantly, the continuous mattress suturing method significantly decreased short-term post-operative complications, including pancreatic leakage (p = 0.042). Furthermore, shorter hospitalization times were observed in the continuous mattress suture group (12.3 ± 5.0 d) than in the interrupted suture group (24.2 ± 11.6 d, p = 0.000).

Conclusions: Continuous mattress suturing is a safe and effective pancreaticoenterostomy method that leads to reduced complications and hospitalization times.

Keywords: Continuous mattress suturing; Pancreatic leakage; Pancreaticoduodenectomy; Pancreaticoenterostomy.

Fig. 1

The first stitch was located at the upper edge of the pancreas. It’s beginning from the outside to the inside of the pancreas, and then from the inside to the outside of the jejunum and then a knot was tied outside

Fig. 2

The posterior of the anastomosis was from upper edge to the lower edge. All the stitches were from the outside to the inside of the jejunum and then transfix the pancreas, and then the stump of pancreas was sutured with jejunum from the inside to the outside. The procedure was repeated until the very lower edge of the pancreas

Fig. 3

The anterior side of the anastomosis was continuously sutured just like the posterior side. All the stitches were from the outside to the inside of the jejunum and then transfix the pancreas. Then the stump of pancreas was sutured with jejunum from the inside to the outside. The procedure was repeated until the very upper edge of the pancreas. A knot was tied at the very end of the suture shown in Fig. 4 blow

Fig. 4

A knot was tied at the very upper edge of the pancreas and the first layer suture was finished

Fig. 5

The second layer suture of the anterior side was location at the very edge of the jejunum just like the first layer. After this suture, the whole anastomosis was finished