Pancreatic Duct-jejunum Anastomosis Formation by Continuous Suturing to the Posterior Wall Utilizing the Parachute Technique Used for Vascular Anastomosis

Abstract

Purpose : Pancreatic fistulas (PFs) following pancreaticoduodenectomy (PD) are a problem that has yet to be overcome. The effectiveness of pancreatic duct-jejunum anastomosis formation by continuous suturing to the posterior wall utilizing the parachute technique used for vascular anastomosis in preventing PF after PD was evaluated.

Methods : The study subjects were 115 patients who underwent PD between 2015 and 2019. The rates of PF were compared between those in whom the pancreatic duct-jejunum anastomosis was formed by interrupted suturing (interrupted suture group, n = 81) and those in whom it was formed by continuous suturing to the posterior wall (continuous suture group, n = 34).

Results : Grade B or worse PF occurred in 18/81 (22%) of the interrupted suture group, but in only 1/34 (3%) of the continuous suture group, which was significantly lower. Multivariate analysis identified preoperative cholangitis and pancreatic duct-jejunum anastomosis method (interrupted suturing) as independent risk factors for Grade B or worse PF.

Conclusions : This new method of pancreatic duct-jejunum anastomosis formation significantly reduced the incidence of postoperative Grade B or worse PF compared with interrupted suturing.