Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 335-344
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.335
Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy
Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang
Bing-Yang Hu, Jian-Jun Leng, Tao Wan, Wen-Zhi Zhang, Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Hu BY and Zhang WZ contributed equally to this work; Hu BY and Zhang WZ designed the research; Hu BY collected and analyzed the data, and drafted the manuscript; Leng JJ and Wan T contributed to analytical tools; all authors have read and approved the final version to be published.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wen-Zhi Zhang, MD, PhD, Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, No. 28 FuXing Road, Beijing 100853, China. zhangwenzhi301301@163.com
Telephone: +86-10-66938331 Fax: +86-10-68241383
Received: March 15, 2015
Peer-review started: March 15, 2015
First decision: April 13, 2015
Revised: May 31, 2015
Accepted: July 15, 2015
Article in press: August 25, 2015
Published online: November 27, 2015
Processing time: 94 Days and 0.2 Hours
Abstract

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. χ2 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.

Keywords: Pancreaticojejunal anastomosis; Pancreatic fistula; Pancreaticoduodenectomy

Core tip: Pancreaticoduodenectomy is a complex surgical procedure with a high perioperative complication rate and a high mortality rate, therefore, pancreaticoduodenectomy is considered a dangerous surgery. Pancreaticojejunal anastomosis plays an important role in pancreaticoduodenectomy; its success determines the success of the surgery. In our study, there was a significant difference in the percentage of patients with grades B and C pancreatic fistula between the two groups. Single-layer anastomosis was better than double-layer anastomosis when the pancreatic texture was soft. The use of this method could reduce the rates of postoperative pancreatic fistula, abdominal infection and peritoneal catheterization.