Chen's penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy

Abstract

Background: Postoperative pancreatic fistula (POPF) is the most serious complication and the main reason for morbidity and mortality after pancreaticoduodenectomy (PD). Currently, there exists no flawless pancreaticojejunal anastomosis approach. We presents a new approach called Chen's penetrating-suture technique for pancreaticojejunostomy (PPJ), which involves end-to-side pancreaticojejunostomy by suture penetrating the full-thickness of the pancreas and jejunum, and evaluates its safety and efficacy.

Methods: To assess this new approach, between May 2006 and July 2018, 193 consecutive patients who accepted the new Chen's Penetrating-Suture technique after a PD were enrolled in this study. Postoperative morbidity and mortality were evaluated.

Results: All cases recovered well after PD. The median operative time was 256 (range 208-352) min, with a median time of 12 (range 8-25) min for performing pancreaticojejunostomy. Postoperative morbidity was 19.7% (38/193) and mortality was zero. The POPF rate was 4.7% (9/193) for Grade A, 1.0% (2/193) for Grade B, and no Grade C cases and one urinary tract infection.

Conclusion: PPJ is a simple, safe, and reliable technique with ideal postoperative clinical results.

Keywords: Chen’s Penetrating-Suture technique; Pancreaticoduodenectomy; Postoperative pancreatic fistula.

Fig. 1

A and B The 4–0 Vicryl suture completely penetrates the pancreatic stump, then continuously penetrates from the posterior to the anterior wall of the jejunal loop. The same method was used to perform the subsequent 6–8 sutures. The stitch suturing the entire layer of the jejunal wall begins, from proximal to distal, approximately 2–3 cm to the resection margin of the loop. These sutures are preplaced approximately 8–10 mm from the cut edge of the pancreatic remnant and the jejunum, 5 mm between each other, and they are not tied until all 6–8 of the sutures have been placed. The first and last suture should be on the outer edge of the jejunum incision, so as to guarantee the pancreatic stump was completely covered with jejunum serosa

Fig. 2

(diagram): Pancreatic stump was covered with jejunal wall and pancreatic duct catheter was put into the jejunum after anastomosis

Fig. 3

A The anterior wall of the anastomosis after being knotted. B The posterior wall of the anastomosis after being knotted