Fish-Mouth Closure of the Pancreatic Stump and Parachuting of the Pancreatic End with Double U Trans-Pancreatic Sutures for Pancreatico-Jejunostomy

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MeSH: Aged ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods* ; Aviation ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Mouth ; Pancreatic Fistula ; Pancreatic Neoplasms/complications ; Pancreatic Neoplasms/surgery* ; Pancreaticoduodenectomy/adverse effects* ; Pancreaticojejunostomy/methods* ; Postoperative Complications/surgery ; Pylorus ; Sutures ; Treatment Outcome

Keywords: Blumgart anastomosis ; Pancreatico-jejunostomy ; Whipple's operation ; fish-mouth closure of pancreatic stump ; post-operative pancreatic fistula (POPF)

Abstract: PURPOSE:

Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple's operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple's operation (hereinafter referred to as Lee's method), with very good results.

MATERIALS AND METHODS:

The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy.

RESULTS:

Eleven cases of pylorus preserving Whipple's operation have been performed without a clinically significant postoperative pancreatic fistula.

CONCLUSION:

This new method (Lee's method) may dramatically reduce the occurrence of postoperative pancreatic fistula after Whipple's operation.