Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy

被引:3
作者
Hu, Bing-Yang [1 ]
Leng, Jian-Jun [1 ]
Wan, Tao [1 ]
Zhang, Wen-Zhi [1 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Dept Hepatobiliary Surg, 28 FuXing Rd, Beijing 100853, Peoples R China
关键词
Pancreaticojejunal anastomosis; Pancreatic fistula; Pancreaticoduodenectomy;
D O I
10.4240/wjgs.v7.i11.335
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
AIM: To investigate the simplicity, reliability, and safety of the application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy. METHODS: A retrospective analysis was performed on the data of patients who received pancreaticoduodenectomy completed by the same surgical group between January 2011 and April 2014 in the General Hospital of the People's Liberation Army. In total, 51 cases received single-layer mucosa-to-mucosa pancreaticojejunal anastomosis and 51 cases received double-layer pancreaticojejunal anastomosis. The diagnoses of pancreatic fistula and clinically relevant pancreatic fistula after pancreaticoduodenectomy were judged strictly by the International Study Group on pancreatic fistula definition. The preoperative and intraoperative data of these two groups were compared chi(2) test and Fisher's exact test were used to analyze the incidences of pancreatic fistula, peritoneal catheterization, abdominal infection and overall complications between the single-layer anastomosis group and double-layer anastomosis group. Rank sum test were used to analyze the difference in operation time, pancreaticojejunal anastomosis time, postoperative hospitalization time, total hospitalization time and hospitalization expenses between the single-layer anastomosis group and double-layer anastomosis group. RESULTS: Patients with grade A pancreatic fistula accounted for 15.69% (8/51) vs 15.69% (8/51) (P = 1.0000), and patients with grades B and C pancreatic fistula accounted for 9.80% (5/51) vs 52.94% (27/51) (P = 0.0000) in the single-layer and double-layer anastomosis groups. Although there was no significant difference in the percentage of patients with grade A pancreatic fistula, there was a significant difference in the percentage of patients with grades B and C pancreatic fistula between the two groups. The operation time (220.059 +/- 60.602 min vs 379.412 +/- 90.761 min, P = 0.000), pancreaticojejunal anastomosis time (17.922 +/- 5.145 min vs 31.333 +/- 7.776 min, P = 0.000), postoperative hospitalization time (18.588 +/- 5.285 d vs 26.373 +/- 15.815 d, P = 0.003), total hospitalization time (25.627 +/- 6.551 d vs 33.706 +/- 15.899 d, P = 0.002), hospitalization expenses (116787.667 +/- 31900.927 yuan vs 162788.608 +/- 129732.500 yuan, P = 0.001), as well as the incidences of pancreatic fistula [13/51 (25.49%) vs 35/51 (68.63%), P = 0.0000], peritoneal catheterization [0/51 (0%) vs 6/51 (11.76%), P = 0.0354], abdominal infection [1/51 (1.96%) vs 11/51 (21.57%), P = 0.0021], and overall complications [21/51 (41.18%) vs 37/51 (72.55%), P = 0.0014] in the single-layer anastomosis group were all lower than those in the double-layer anastomosis group. CONCLUSION: Single-layer mucosa-to-mucosa pancreaticojejunal anastomosis appears to be a simple, reliable, and safe method. Use of this method could reduce the postoperative incidence of complications.
引用
收藏
页码:335 / 344
页数:10
相关论文
共 32 条
[1]   Zero mortality after 152 consecutive pancreaticoduodenectomies with pancreaticogastrostomy [J].
Aranha, GV ;
Hodul, PJ ;
Creech, S ;
Jacobs, W .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2003, 197 (02) :223-231
[2]   Postoperative pancreatic fistula: An international study group (ISGPF) definition [J].
Bassi, C ;
Dervenis, C ;
Butturini, G ;
Fingerhut, A ;
Yeo, C ;
Izbicki, J ;
Neoptolemos, J ;
Sarr, M ;
Traverso, W ;
Buchler, M .
SURGERY, 2005, 138 (01) :8-13
[3]   Changes in morbidity after pancreatic resection -: Toward the end of completion pancreatectomy [J].
Büchler, MW ;
Wagner, M ;
Schmied, BM ;
Uhl, W ;
Friess, H ;
Z'graggen, K .
ARCHIVES OF SURGERY, 2003, 138 (12) :1310-1314
[4]   Pancreatic fistula: definition and current problems [J].
Butturini, Giovanni ;
Daskalaki, Despoina ;
Molinari, Enrico ;
Scopelliti, Filippo ;
Casarotto, Andrea ;
Bassi, Claudio .
JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY, 2008, 15 (03) :247-251
[5]   Prevention and Management of Pancreatic Fistula [J].
Callery, Mark P. ;
Pratt, Wande B. ;
Vollmer, Charles M., Jr. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2009, 13 (01) :163-173
[6]   Clinical and economic consequences of pancreatic fistula after elective pancreatic resection [J].
Cecka, Filip ;
Jon, Bohumil ;
Subrt, Zdenek ;
Ferko, Alexander .
HEPATOBILIARY & PANCREATIC DISEASES INTERNATIONAL, 2013, 12 (05) :533-539
[7]   Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery [J].
Connor, S ;
Alexakis, N ;
Garden, OJ ;
Leandros, E ;
Bramis, J ;
Wigmore, SJ .
BRITISH JOURNAL OF SURGERY, 2005, 92 (09) :1059-1067
[8]   Standard resection of pancreatic cancer and the chance for cure [J].
Erdmann, Joris ;
van Eijck, Casper H. J. ;
Jeekel, Johannes .
AMERICAN JOURNAL OF SURGERY, 2007, 194 (4A) :S104-S109
[9]  
Furuta Kazunori, 2008, Surg Technol Int, V17, P150
[10]   Novel Pancreaticojejunostomy with a Low Rate of Anastomotic Failure-Related Complications [J].
Grobmyer, Stephen R. ;
Kooby, David ;
Blumgart, Leslie H. ;
Hochwald, Steven N. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2010, 210 (01) :54-59