Application of duct-to-mucosa continuous anastomosis in the pancreaticojejunostomy

Objective: Pancreaticojejunostomy is the most important anastomosis in Whipple operations, it's closely related to the pancreatic fistula. Present a variety of pancreatic enteric anastomosis methods have advantages and disadvantages, this study was to explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods: Clinical data from June 2013 to June 2015 of 165 pancreaticoduodenectomy resection patients were retrospectively analyzed, at the FourthHospital ofHebeiMedicalUniversity,HepatobiliarySurgery.Of the patients, 53 patients with Prolene line continuous duct-to-mucosa, and 112 patients with end-to-side of pancreatic anastomosis were used. Diagnostic criteria referenced the International pancreatic fistula Study Group (ISGPF) defined in 2005. Statistical analysis was performed with the c2 test. A probability value of less than 0.05 was considered statistically significant. Descriptionof operateprocess: Select themainpancreatic ductdiameterover 1.5mm patients. Briefly, upon completion of the PD, the pancreatic remnant was mobilized for 1e2 cm to allow adequate placement of the posterior outer-layer sutures.Find the main pancreatic duct, and suture the bleeding section. The posterior outer-layer anastomosis was performed by using continuous suture technique. Generally, double needle 4-0 prolene sutures were placed starting at the pancreatic remnant andwere continued through the seromuscular layer of the backwall of the jejunum.A 2mmdiameter hole was poked on the jejunum nearing the main pancreatic duct. Double needle 5-0 prolene line continuous suture the whole jejunal wall and the paries posterior of pancreatic duct. Select appropriate diameter internal plastic stent, the end of the stent was positioned within the pancreatic duct. Place the other end of the stent into the jejunum. Then the similar process was performedwith 5-0 prolene line continuous suturing the whole jejunal wall and the antetheca of pancreatic duct. Finally 4-0Prolene continuous suture the seromuscular layer of the jejunum and the anterior wall of pancreas. Results: The incidence of pancreatic fistulas in patients with prolene line continuous suture was 3.8%(2/53), and in those with end-to-side suture it was 15.2% (17/112) (P < 0.05). According to the international clinical grading system, grade A of POPF was found in 2 patients of the prolene line continuous suture group, and were successfully discharged under the conservative treatment. Conclusion: This method of duct-to-mucosa anastomosis with Prolene line continuous suturing is simple and time-saving with obviously reducing incidence of pancreatic fistula. It's continuous anastomosis of main pancreatic duct and the whole jejunum layer, exactly, not easy to occur pancreatic fistula, less affected by the pancreas texture. The Prolene thread and Needle as a whole, lines of smooth, less friction, is suitable for continuous anastomosis. This method of anastomosis is proved to be safe and efficient in preventing pancreatic fistula.