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How to do a safe pancreatic anastomosis
Author(s) -
Z'graggen Kaspar,
Uhl Waldemar,
Friess Helmut,
Büchler Markus W.
Publication year - 2002
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340200101
Subject(s) - medicine , anastomosis , pancreatic fistula , pancreatic duct , pancreatic head , surgery , fistula , resection , mortality rate , pancreas , general surgery , pancreatitis
Background/Purpose Leakage of pancreaticojejunostomies has been associated with morbidity and mortality after pancreatic head resection. Different techniques have been described to perform a safe anastomosis to the left pancreatic remnant. Methods The pancreaticojejunostomy is preferably performed as an end‐to‐side anastomosis; drainage of the pancreatic duct by catheters or stents is not performed at our institution. Results Experience in more than 331 patients who underwent pancreaticojejunostomy indicates that a two‐layer, single‐stitch technique, with absorbable monofilament sutures and duct‐to‐mucosa adaptation, is a reliable method, with a pancreatic fistula rate of 2%. Conclusions The results obtained with the described technique of pancreaticojejunostomy indicate that the pancreatic anastomosis is very safe when performed by experienced hands and does not necessarily contribute to morbidity and mortality after pancreatic head resection. The prevalence of pancreatic fistulae and intraabdominal abscesses may further decrease, and the prevalence of nonpancreatic complications may have a more important impact on the outcome in the future.