Comparative study on anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

AN Xiang ^1,2 ,  HU Weiming ¹ , LU Huimin ¹

1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Hepatopancreatobiliary Surgery, East-City Ward of Sichuan Province People’s Hospital, Chengdu 610101, P. R. China;

Corresponding?author：

HU Weiming, Email: huweiming64@163.com

Keywords：

pancreaticoduodenectomy; pancreaticojejunostomy; postoperative complications; pancreatic fistula

DOI：

10.7507/1007-9424.201711008

Video：

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Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.

Citation： AN Xiang, HU Weiming, LU Huimin. Comparative study on anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(4): 428-432. doi: 10.7507/1007-9424.201711008 Copy

1.	Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg, 1935, 102(4): 763-779.
2.	Wellner UF, Sick O, Olschewski M, et al. Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg, 2012, 16(9): 1686-1695.
3.	Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol, 2013, 14(7): 655-662.
4.	趙玉沛. 胰十二指腸切除術現狀與展望. 中國實用外科雜志, 2016, (08): 817-820.
5.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, 161(3): 584-591.
6.	Ibrahim S, Tay KH, Launois B, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Dig Surg, 2006, 23(5-6): 296-302.
7.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
8.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
9.	Bai X, Zhang Q, Gao S, et al. Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon. J Am Coll Surg, 2016, 222(1): 10-18.
10.	孫備, 陳宏澤. 胰十二指腸切除術后消化道重建方式的選擇. 中華消化外科雜志, 2015, 14(11): 911-915.
11.	Lermite E, Sommacale D, Piardi T, et al. Complications after pancreatic resection: diagnosis, prevention and management. Clin Res Hepatol Gastroenterol, 2013, 37(3): 230-239.
12.	Fontes PR, Waechter FL, Nectoux M, et al. Low mortality rate in 97 consecutive pancreaticoduodenectomies: the experience of a group. Arq Gastroenterol, 2014, 51(1): 29-33.
13.	劉續寶, 熊俊杰. 從遠期生活質量再議胰腸吻合與胰胃吻合合理選擇. 中國實用外科雜志, 2016, (08): 839-843.
14.	中華醫學會外科學分會. 胰腺切除術后消化道重建技術專家共識. 中國實用外科雜志, 2014, 34(3): 227-230.
15.	He T, Zhao Y, Chen Q, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. Dig Surg, 2013, 30(1): 56-69.
16.	徐松, 田伯樂, 蘇安平, 等. 去除空腸漿膜層的胰腸黏膜-黏膜 3 層吻合法在胰十二指腸切除術胰腸重建中的運用[J]. 中國普外基礎與臨床雜志, 2014,21(7):809-815.
17.	Su AP, Zhang Y, Ke NW, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa decreased pancreatic fistula after pancreaticoduodenectomy. J Surg Res, 2014, 186(1): 184-191.
18.	苗毅, 衛積書. 從機械連接到生物愈合: 對胰腸吻合新理解. 中國實用外科雜志, 2015, 35(8): 812-814.
19.	陳一帆, 劉巍, 花榮, 等. 根據胰管直徑等因素選擇不同胰腸吻合方式對患者術后恢復的影響. 肝膽胰外科雜志, 2014, 26(3): 181-184.
20.	Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
21.	Markar SR, Vyas S, Karthikesalingam A, et al. The impact of pancreatic duct drainage following pancreaticojejunostomy on clinical outcome. J Gastrointest Surg, 2012, 16(8): 1610-1617.
22.	Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
23.	Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
24.	Hashimoto D, Chikamoto A, Ohmuraya M, et al. Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy. Surg Today, 2014, 44(7): 1207-1213.
25.	趙玉沛, 張太平. 消化道重建基本原則與基本技術. 中國實用外科雜志, 2014, 34(3): 197-204.

1. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg, 1935, 102(4): 763-779.
2. Wellner UF, Sick O, Olschewski M, et al. Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg, 2012, 16(9): 1686-1695.
3. Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol, 2013, 14(7): 655-662.
4. 趙玉沛. 胰十二指腸切除術現狀與展望. 中國實用外科雜志, 2016, (08): 817-820.
5. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, 161(3): 584-591.
6. Ibrahim S, Tay KH, Launois B, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Dig Surg, 2006, 23(5-6): 296-302.
7. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
8. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
9. Bai X, Zhang Q, Gao S, et al. Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon. J Am Coll Surg, 2016, 222(1): 10-18.
10. 孫備, 陳宏澤. 胰十二指腸切除術后消化道重建方式的選擇. 中華消化外科雜志, 2015, 14(11): 911-915.
11. Lermite E, Sommacale D, Piardi T, et al. Complications after pancreatic resection: diagnosis, prevention and management. Clin Res Hepatol Gastroenterol, 2013, 37(3): 230-239.
12. Fontes PR, Waechter FL, Nectoux M, et al. Low mortality rate in 97 consecutive pancreaticoduodenectomies: the experience of a group. Arq Gastroenterol, 2014, 51(1): 29-33.
13. 劉續寶, 熊俊杰. 從遠期生活質量再議胰腸吻合與胰胃吻合合理選擇. 中國實用外科雜志, 2016, (08): 839-843.
14. 中華醫學會外科學分會. 胰腺切除術后消化道重建技術專家共識. 中國實用外科雜志, 2014, 34(3): 227-230.
15. He T, Zhao Y, Chen Q, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. Dig Surg, 2013, 30(1): 56-69.
16. 徐松, 田伯樂, 蘇安平, 等. 去除空腸漿膜層的胰腸黏膜-黏膜 3 層吻合法在胰十二指腸切除術胰腸重建中的運用[J]. 中國普外基礎與臨床雜志, 2014,21(7):809-815.
17. Su AP, Zhang Y, Ke NW, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa decreased pancreatic fistula after pancreaticoduodenectomy. J Surg Res, 2014, 186(1): 184-191.
18. 苗毅, 衛積書. 從機械連接到生物愈合: 對胰腸吻合新理解. 中國實用外科雜志, 2015, 35(8): 812-814.
19. 陳一帆, 劉巍, 花榮, 等. 根據胰管直徑等因素選擇不同胰腸吻合方式對患者術后恢復的影響. 肝膽胰外科雜志, 2014, 26(3): 181-184.
20. Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
21. Markar SR, Vyas S, Karthikesalingam A, et al. The impact of pancreatic duct drainage following pancreaticojejunostomy on clinical outcome. J Gastrointest Surg, 2012, 16(8): 1610-1617.
22. Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
23. Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
24. Hashimoto D, Chikamoto A, Ohmuraya M, et al. Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy. Surg Today, 2014, 44(7): 1207-1213.
25. 趙玉沛, 張太平. 消化道重建基本原則與基本技術. 中國實用外科雜志, 2014, 34(3): 197-204.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative study on anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy

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