The pancreatojejunostomy after pancreatoduodenectomy. The review of techniques including our own method of the anastomosis
Journal Title: Postępy Nauk Medycznych - Year 2011, Vol 24, Issue 1
Abstract
Pancreaticoduodenectomy (PD) is the treatment of choice for resectable periampullary tumors. The most difficult, time-consuming, and complication-prone step in pancreaticoduodenectomy is the pancreaticojejunostomy step. Different surgical techniques for anastomosis have been attempted to decrease the incidence of pancreatic fistula (PF). Leakage from pancreatic anastomosis remains the single most important cause of morbidity, and it also contributes significantly to prolonged hospitalization and mortality. The best technique in pancreatic anastomosis is still debated. The choice of anastomotic methods might be based on the preference of surgeon or individual characteristics of each patient. From a technical standpoint, an “ideal” pancreaticojejunal anastomosis would meet the following criteria: applicable to all patients, easy to teach, and associated with a low rate of pancreatic anastomotic failure-related complications. More than 80 different methods of pancreaticoenteric reconstruction have been proposed, illustrating the complexity of surgical techniques as well as the absence of a gold standard. Authors describe two main types of anastomosis: pancreatojejunostomy, so-called invagination anastomosis, and pancreaticojejunostomy, so-called duct-to-mucosa anastomosis. They cite retrospective and prospective studies describing various operating techniques taking into consideration the placement method of sutures (interrupted suture and continuous suture), number of layers of the anastomosis, the use of additional surgical amenities (microscope, loup, and other surgical equipment), the use of additional surgical safety measures (stenting, polypropylene mesh, omental flap, fibrin glue). The authors also present their own pancreatojejunostomy modification after pancreatoduodenectomy.
Authors and Affiliations
Katarzyna Kuśnierz, Sławomir Mrowiec, Paweł Lampe
Keywords
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