Pancreatico-Gastric Anastomosis with and without Sutures – Experimental Swine Model

Open access

Abstract

Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches.

Methods. Our experimental model is based on ten piglets, which were divided into 2 groups. In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas.

Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group.

Conclusions. In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

1. Allema JH, Reinders ME, van Gulik TM, Koelemay MJ, Van Leeuwen DJ, de Wilt LT, et al. Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer, 1995;75:2069-2076.

2. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg, 1993;217:430–435.

3. Miedema BW, Sarr MG, van Heerden JA, Nagorney DM, McIlrath DC, Ilstrup D. Complications following pancreaticoduodenectomy: current management. Arch Surg, 1992;127:945–949.

4. Haddad LBP, Scatton O, Randone B, Andraus W, Massault P, Dousset B, Soubrane O. Pancreatic fistula after pancreaticoduodenectomy: the conservative treatment of choice. HPB (Oxford), 2009;11:203–209.

5. Butturini G, Daskalaki D, Molinari E, Scopelliti F, Casarotto A, Bassi C. Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg. 2008;15: 247–251.

6. Akamatsu, N., Sugawara, Y., Komagome, M., Shin, N., Cho, N., Ishida, T., Ozawa, F. and Hashimoto, D. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. Journal of Hepato-Biliary-Panc, 2010;17:322–328.

7. Falconi M, Pederzoli P. The relevance of gastrointestinal fistulae in clinical practice: a review. Gut, 2001; 49 (Suppl 4): iv2–iv10.

8. Yeo CJ, Cameron JL, Sohn TA et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg, 1997;226:248-260.

9. Bachellier P, Oussoultzoglou E, Rosso E, Scurtu R, Lucescu I, Oshita A, Jaeck D. Pancreatogastrostomy as a Salvage Procedure to Treat Severe Postoperative Pancreatic Fistula After Pancreatoduodenectomy. Arch Surg, 2008;143:966-970.

10. Zhu F, Wang M, Wang X, Tian R, Shi C, Xu M, Shen M, Han J, Luo N, Qin R. Modified Technique of Pancreaticogastrostomy for Soft Pancreas with Two Continuous Hemstitch Sutures: A Single-Center Prospective Study. J Gastrointest Surg, 2013;17:1306–1311.

11. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P: Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg, 2005;242:767–771.

12. Niedergethmann M, Dusch N, Widyaningsih R, Weiss C, Kienle P, Post S: Risk-adapted anastomosis for partial pancreaticoduodenectomy reduces the risk of pancreatic fistula: a pilot study. World J Surg, 2010;34:1579–1586.

13. Fernandez-Cruz L, Cosa R, Blanco L, Lopez-Boado MA, Astudillo E: Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg, 2008;248:930–938.

14. Aranha GV, Hodul P, Golts E, Oh D, Pickleman J, Creech S. A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. Journal of Gastrointestinal Surgery, 2003;7:672–682.

15. Bassi C, Falconi M, Molinari E, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Annals of Surgery, 2005;242:767–773.

16. Bartsch DK, Langer P, Kanngiesser V, Fendrich V, Dietzel K: A simple and safe anastomosis for pancreatogastrostomy using one binding purse-string and two transfixing mattress sutures. Int J Surg Oncol, 2012:718637.

17. Adams DB: The pancreatic anastomosis: the danger of a leak, which anastomotic technique is better? J Gastrointest Surg, 2009;13:1182–1183.

18. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, Salvia R, Pederzoli P: Duct-to-mucosa versus endto-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery, 2003; 134:766–771.

19. Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, Hyslop T, Schmidt CM, Rosato EL, Lavu H, et al: Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dualinstitution trial. J Am Coll Surg, 2009;208:738–747.

20. Cameron JL, Riall TS, Coleman J, Belcher KA: One thousand consecutive pancreaticoduodenectomies. Ann Surg, 2006;244:10–15.

21. Su CH, Shyr YM, Lui WY, P’eng FK. Factors affecting morbidity, mortality and survival after pancreaticoduodenectomy for carcinoma of the ampulla of Vater. Hepatogastroenterology, 1999; 46:1973-1979.

22. Pellegrini CA, Heck CF, Raper S, Way LW. An analysis of the reduced morbidity and mortality rates after pancreati-coduodenectomy. Arch Surg, 1989;124:778–781.

23. Ming-Dong Bai, Liang-Qun Rong, Lian-Chen Wang, Hai Xu, Rui-Fang Fan, Pei Wang, Xiao-Peng Chen, Liu-Bin Shi, and Shu-You Peng. Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function. World J Gastroenterol, 2008; 14:441–447.

24. Hamanaka Y, Nishihara K, Hamasaki T, Kawabata A, Yamamoto S, Tsurumi M, Ueno T, Suzuki T. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage. Surgery, 1996;119:281-287.

25. Yeo CJ, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg, 1995;222:580-592.

26. Duffas JP, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg, 2005;189:720-729.

27. Peng SY, et al. A pancreas suture-less type II binding pancreaticogastrostomy. Zhonghua wai ke za zhi [Chinese journal of surgery], 2009; 47:1764-1766.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 138 133 12
PDF Downloads 63 61 6