Invited Commentary

Excerpt

Langrehr et al. (DOI: 10.1007/s00268-005-7875-0) have undertaken a major randomized controlled trial to study a surgically relevant technical issue; to assess a new “mattress-suture” technique, which simplifies the dunking pancreaticojejunostomy. This technique is compared with the standard “Cattell” duct-to-mucosa anastomosis for ease of performance, postoperative complications, and alteration of endocrine and exocrine function during the first postoperative year. Some surgeons espouse the “dunking” procedure for the pancreatic anastomosis, considering it to result in fewer pancreatic fistulae and to be easier to perform than the standard end-to-side anastomosis. The duct-to-mucosa anastomosis is closer to the surgical norm, where mucosa-to-mucosa healing prevents anastomotic inflammation [1] and long-term stricturing and therefore offers better long-term function. However, the difficulties of performing pancreaticojejunostomy may lead to life-threatening complications, and for this reason other techniques have been developed. …