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Pancreaticojejunal anastomosis, using a stent tube, in pancreaticoduodenectomy

Published on May 1, 2009in Journal of Hepato-biliary-pancreatic Surgery
· DOI :10.1007/s00534-009-0072-z
Wataru Kimura33
Estimated H-index: 33
(YU: Yamagata University)
Abstract
We report our technique for pancreaticojejunostomy, using a stent tube, and examine the literature with regard to the use of a stent tube in pancreaticojejunostomy. The total number of stitches in the anastomosis of the pancreatic parenchyma and seromuscle layer of the jejunum should be more than 20, and there should be more than 8 stitches in the anastomosis of the pancreatic duct and parenchyma and all layers of the jejunal wall, even in a normal-sized main pancreatic duct. There is no dead space between the cut end of the pancreatic parenchyma and the jejunal wall. None of the 114 consecutive patients who underwent pancreaticoduodenectomy in our series died. We use a stent because this makes it easier to perform anterior wall anastomosis of the pancreaticojejunostomy. It is easy to find the pancreaticojejunal anastomosis at the anterior wall anastomosis. We never stitch the posterior wall of the anastomosis with a stent tube in place at the anterior wall anastomosis. If the anastomosis leaks, the massive flow of pancreatic juice around the anastomosis is prevented because of the pancreatic juice flowing out of the pancreatic tube.
  • References (8)
  • Citations (16)
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References8
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#1Toshihide Imaizumi (Tokai University)H-Index: 17
#2Takashi HatoriH-Index: 26
Last. Hiroyasu Makuuchi (Tokai University)H-Index: 32
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Background Purpose There is a high risk of anastomotic leakage after pancreaticojejunostomy following pancreaticoduodenectomy in patients with a normal soft pancreas because of the high degree of exocrine function. Therefore, pancreaticojejunostomy is generally performed using a stenting tube (stented method). However, pancreaticojejunostomy with a certain duct-to-mucosa anastomosis does not always require a stenting tube, even in patients with a normal soft pancreas. Recently, we have performed...
54 CitationsSource
#1Masajitani (Wakayama Medical University)H-Index: 28
#2Hironobu Onishi (Wakayama Medical University)H-Index: 13
Last. Hirokiyamaue (Wakayama Medical University)H-Index: 44
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This study was conducted to examine the efficacy of duct-to-mucosal pancreaticojejunostomy compared with external stented pancreaticojejunostomy in prevention of several complications, retrospectively. Seventy-six patients with pancreatic head resection (59 male; median age, 60.1 years) underwent pancreaticoduodenectomy at the Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan, between January 1, 1994, and March 31, 2002. In early postoperative status,...
58 CitationsSource
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#2J.L FaucheronH-Index: 1
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We devised a new technique to increase the safety of pancreaticojejunostomy in patients with an extended operation for pancreatic cancer. This new pancreaticojejunostomy was created by end-to-side anastomosis with four layers about 7 cm distal to the jejunal stump. The cut surface of the pancreas was placed on the seromuscular coat of the ventral aspect of the jejunum to cover the posterior surface of the anastomosis, and the anastomosis between the pancreas and the jejunum was created using fib...
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Background Several studies have demonstrated that the use of pancreatic duct stents following pancreaticoduodenectomy is associated with a lower risk of pancreatic fistula. However, to date there is a lack of accord in the literature on whether the use of stents is beneficial and, if so, whether internal or external stenting, with or without replacement, is preferable. This is an update of a systematic review. Objectives To determine the efficacy of pancreatic stents in preventing pancreatic fis...
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Background Postoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call “true” duct-to-mucosa anastomosis (DMA)—pancreaticojejunostomy.
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Background The effectiveness of an external pancreatic duct stent for reduction of the pancreatic fistula after pancreaticoduodenectomy remains controversial.
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