Skip to main content
Top
Published in: BMC Surgery 1/2023

Open Access 01-12-2023 | Pancreaticojejunostomy | Research

Chen’s penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy

Authors: Lihong Zhang, Xuefeng Zhu, Yongsheng Zhu, Jianjun Huang, Lide Tao, Yijun Chen

Published in: BMC Surgery | Issue 1/2023

Login to get access

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.
Literature
2.
go back to reference Wolfgang CL, Pawlik TM. Pancreaticoduodenectomy: time to change our approach? Lancet Oncol. 2013;14:573–5.CrossRefPubMed Wolfgang CL, Pawlik TM. Pancreaticoduodenectomy: time to change our approach? Lancet Oncol. 2013;14:573–5.CrossRefPubMed
3.
go back to reference Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreatico-gastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–62.CrossRefPubMed Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreatico-gastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–62.CrossRefPubMed
4.
go back to reference Narayanan S, Martin AN, Turrentine FE, et al. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res. 2018;231:304–8.CrossRefPubMedPubMedCentral Narayanan S, Martin AN, Turrentine FE, et al. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res. 2018;231:304–8.CrossRefPubMedPubMedCentral
5.
go back to reference Complications SR, Pancreaticoduodenectomy A. Surg Clin North Am. 2021;101:865–74.CrossRef Complications SR, Pancreaticoduodenectomy A. Surg Clin North Am. 2021;101:865–74.CrossRef
6.
go back to reference Senda Y, Shimizu Y, Natsume S, Ito S, Komori K, Abe T, Matsuo K, Sano T. Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy. Br J Surg. 2018;105:48–57.CrossRefPubMed Senda Y, Shimizu Y, Natsume S, Ito S, Komori K, Abe T, Matsuo K, Sano T. Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy. Br J Surg. 2018;105:48–57.CrossRefPubMed
7.
go back to reference Zhang X, Dong X, Liu P, Yan Y, Wei Y, Zechner D, Gong P, Vollmar B. Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula : A Systematic Review and Meta-Analysis. Dig Surg. 2017;34:265–80.CrossRefPubMed Zhang X, Dong X, Liu P, Yan Y, Wei Y, Zechner D, Gong P, Vollmar B. Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula : A Systematic Review and Meta-Analysis. Dig Surg. 2017;34:265–80.CrossRefPubMed
8.
go back to reference Xu J, Zhang B, Shi S, Qin Y, Ji S, Xu W, Liu J, Liu L, Liu C, Long J, Ni Q, Yu X. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized trial. Surgery. 2015;158(5):1211–8.CrossRefPubMed Xu J, Zhang B, Shi S, Qin Y, Ji S, Xu W, Liu J, Liu L, Liu C, Long J, Ni Q, Yu X. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized trial. Surgery. 2015;158(5):1211–8.CrossRefPubMed
9.
go back to reference Chen YJ, Zhu X, Huang JJ, et al. Penetrating-suture type of pancreaticojejunostomy. Chin J Hepatobiliary Surg. 2012;18:81–4. Chen YJ, Zhu X, Huang JJ, et al. Penetrating-suture type of pancreaticojejunostomy. Chin J Hepatobiliary Surg. 2012;18:81–4.
10.
go back to reference Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.CrossRefPubMed Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.CrossRefPubMed
11.
go back to reference Shah MM, Martin BM, Stetler JL, Patel AD, Davis SS, Sarmiento JM, Lin E. Reconstruction options for pancreaticoduodenectomy in patients with prior roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech A. 2017;27:1185–91.CrossRefPubMed Shah MM, Martin BM, Stetler JL, Patel AD, Davis SS, Sarmiento JM, Lin E. Reconstruction options for pancreaticoduodenectomy in patients with prior roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech A. 2017;27:1185–91.CrossRefPubMed
12.
go back to reference Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, Clark CJ. Modified frailty index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2017;24:1714–21.CrossRefPubMedPubMedCentral Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, Clark CJ. Modified frailty index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2017;24:1714–21.CrossRefPubMedPubMedCentral
13.
go back to reference E Nakeeb A, E Sorogy M, Hamed H, et al. Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management.Hepatobiliary Pancreat Dis Int. 2019;18(1):67–72 E Nakeeb A, E Sorogy M, Hamed H, et al. Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management.Hepatobiliary Pancreat Dis Int. 2019;18(1):67–72
14.
go back to reference Karabicak I, Satoi S, Yanagimoto H, et al. Comparison of surgical outcomes of three different stump closure techniques during distal pancreatectomy. Pancreatology. 2017;17:497–503.CrossRefPubMed Karabicak I, Satoi S, Yanagimoto H, et al. Comparison of surgical outcomes of three different stump closure techniques during distal pancreatectomy. Pancreatology. 2017;17:497–503.CrossRefPubMed
15.
go back to reference Zhang L, Li Z, Wu X, et al. Sealing pancreaticojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layer anastomosis: a novel technique to prevent pancreatic fistula after pancreaticoduodenectomy. J Am Coll Surg. 2015;220:e71-77.CrossRefPubMed Zhang L, Li Z, Wu X, et al. Sealing pancreaticojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layer anastomosis: a novel technique to prevent pancreatic fistula after pancreaticoduodenectomy. J Am Coll Surg. 2015;220:e71-77.CrossRefPubMed
16.
go back to reference Cao X, Wang X, Zhao B, et al. Correlation between Intraoperative fluid administration and outcomes of pancreatoduodenectomy. Gastroenterol Res Pract. 2020;2020:8914367.CrossRefPubMedPubMedCentral Cao X, Wang X, Zhao B, et al. Correlation between Intraoperative fluid administration and outcomes of pancreatoduodenectomy. Gastroenterol Res Pract. 2020;2020:8914367.CrossRefPubMedPubMedCentral
17.
go back to reference McMillan MT, Vollmer CM Jr. Predictive factors for pancreatic fistula following pancreatectomy. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2014;399:811–24.CrossRef McMillan MT, Vollmer CM Jr. Predictive factors for pancreatic fistula following pancreatectomy. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2014;399:811–24.CrossRef
18.
go back to reference Hayashi H, Amaya K, Fujiwara Y, et al. Comparison of three fistula risk scores after pancreatoduodenectomy: a single-institution retrospective study. Asian J Surg. 2021;44(1):143–6.CrossRefPubMed Hayashi H, Amaya K, Fujiwara Y, et al. Comparison of three fistula risk scores after pancreatoduodenectomy: a single-institution retrospective study. Asian J Surg. 2021;44(1):143–6.CrossRefPubMed
19.
go back to reference Harrell KN, Jajja MR, Postlewait LM, et al. Influence of margin histology on development of pancreatic fistula following pancreatoduodenectomy. J Surg Res. 2020;246:315–24.CrossRefPubMed Harrell KN, Jajja MR, Postlewait LM, et al. Influence of margin histology on development of pancreatic fistula following pancreatoduodenectomy. J Surg Res. 2020;246:315–24.CrossRefPubMed
20.
go back to reference McMillan MT, Malleo G, Bassi C, S, et al. Pancreatic fistula risk for pancreatoduodenectomy: an international survey of surgeon perception. HPB (Oxford). 2017;19(6):515–524. McMillan MT, Malleo G, Bassi C, S, et al. Pancreatic fistula risk for pancreatoduodenectomy: an international survey of surgeon perception. HPB (Oxford). 2017;19(6):515–524.
21.
go back to reference Andrianello S, Marchegiani G, Malleo G, et al. Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3. Randomized Clinical Trial JAMA Surg. 2020;155:313–21.PubMed Andrianello S, Marchegiani G, Malleo G, et al. Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3. Randomized Clinical Trial JAMA Surg. 2020;155:313–21.PubMed
22.
go back to reference Xiang Y, Wu J, Lin C, et al. Pancreatic reconstruction techniques after pancreaticoduodenectomy: a review of the literature. Expert Rev Gastroenterol Hepatol. 2019;13:797–806.CrossRefPubMed Xiang Y, Wu J, Lin C, et al. Pancreatic reconstruction techniques after pancreaticoduodenectomy: a review of the literature. Expert Rev Gastroenterol Hepatol. 2019;13:797–806.CrossRefPubMed
23.
go back to reference Sun X, Zhang Q, Zhang J, et al. Meta-analysis of invagination and duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: an update. Int J Surg. 2016;36:240–7.CrossRefPubMed Sun X, Zhang Q, Zhang J, et al. Meta-analysis of invagination and duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: an update. Int J Surg. 2016;36:240–7.CrossRefPubMed
24.
go back to reference Kim M, Shin WY, Lee KY, et al. An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures. Ann Hepatobiliary Pancreat Surg. 2017;21(1):39–47.CrossRefPubMedPubMedCentral Kim M, Shin WY, Lee KY, et al. An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures. Ann Hepatobiliary Pancreat Surg. 2017;21(1):39–47.CrossRefPubMedPubMedCentral
25.
go back to reference Gomez T, Palomares A, Serradilla M, et al L. Reconstruction after pancreato-duodenectomy: Pancreatojejunostomy vs pancreatogastr-ostomy. World J Gastrointest Oncol. 2014;6:369–376. Gomez T, Palomares A, Serradilla M, et al L. Reconstruction after pancreato-duodenectomy: Pancreatojejunostomy vs pancreatogastr-ostomy. World J Gastrointest Oncol. 2014;6:369–376.
26.
go back to reference Han HJ, Choi SB, Lee JS, et al. Reliability of continuous suture of pancreaticojejunostomy after pancreaticoduodenectomy. Hepato Gastro Enterol. 2011;58:2132–9. Han HJ, Choi SB, Lee JS, et al. Reliability of continuous suture of pancreaticojejunostomy after pancreaticoduodenectomy. Hepato Gastro Enterol. 2011;58:2132–9.
27.
go back to reference Chen Y, Ke N, Tan C, Zhang H, Wang X, Mai G, Liu X. Continuous versus interrupted suture techniques of pancreaticojejunostomy after pancreaticoduodenectomy. J Surg Res. 2015;193(2):590–7.CrossRefPubMed Chen Y, Ke N, Tan C, Zhang H, Wang X, Mai G, Liu X. Continuous versus interrupted suture techniques of pancreaticojejunostomy after pancreaticoduodenectomy. J Surg Res. 2015;193(2):590–7.CrossRefPubMed
28.
go back to reference Buc E, Flamein R, Golffier C, et al. Peng’s binding pancreatico-jejunostomy after pancreaticoduodenectomy: a French prospective study. J Gastrointest Surg. 2010;14:705–10.CrossRefPubMed Buc E, Flamein R, Golffier C, et al. Peng’s binding pancreatico-jejunostomy after pancreaticoduodenectomy: a French prospective study. J Gastrointest Surg. 2010;14:705–10.CrossRefPubMed
29.
go back to reference Martino DI, M, Mora-Guzman I, Blanco-Traba YG, Díaz MC, Khurram MA, Martín-Pérez E. Predictive Factors of Pancreatic Fistula After Pancreaticoduodenectomy and External Validation of Predictive Scores. Anticancer Res. 2019;39(1):499–504.CrossRefPubMed Martino DI, M, Mora-Guzman I, Blanco-Traba YG, Díaz MC, Khurram MA, Martín-Pérez E. Predictive Factors of Pancreatic Fistula After Pancreaticoduodenectomy and External Validation of Predictive Scores. Anticancer Res. 2019;39(1):499–504.CrossRefPubMed
Metadata
Title
Chen’s penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy
Authors
Lihong Zhang
Xuefeng Zhu
Yongsheng Zhu
Jianjun Huang
Lide Tao
Yijun Chen
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2023
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-023-02054-y

Other articles of this Issue 1/2023

BMC Surgery 1/2023 Go to the issue