Proposal for a Safe and Functional Pancreaticojejunostomy Technique from a Histopathological Perspective

Abstract

Background: To prevent leakage of pancreatic juice from the main pancreatic duct (MPD), complete external drainage appears to be the most effective technique. However, because this requires a pancreatic stent tube to be ligated with MPD, duct-to-mucosa pancreaticojejunostomy (PJ) is difficult. From our histopathological examination, a large amount of pancreatic juice is drained from the ducts other than MPD. This study aimed to evaluate our new conceptual technique of PJ after pancreaticoduodenectomy (PD).

Methods: We considered it important to drain pancreatic juice from the branch pancreatic ducts to the intestinal tract and to perform duct-to-mucosa PJ, while pancreatic juice from MPD is completely drained out of the body. We designed a technique that could simultaneously achieve these points. In our technique, which is based on conventional "two-row" anastomosis, a stent tube is fixed with MPD and its surrounding tissue by purse-string suture at the cut surface of the pancreas, and duct-to-mucosa PJ is concomitantly performed.

Results: Of 45 patients undergoing PD, 12 of soft pancreas underwent surgery with this technique. According to the classification of the International Study Group on Pancreatic Fistula, a Grade A PF was observed in four patients, whereas no patient had a Grade B or C PF.

Conclusions: We propose our anastomotic technique that could simultaneously prevent PF and keep the pancreatic duct patent.