Pancreaticojejunostomy after pancreatoduodenectomy. Special reference to duct-mucosal suture method and an analysis of pancreatic anastomotic insufficiency.:-SPECIAL REFERENCE TO DUCT-MUCOSAL SUTURE METHOD AND AN ANALYSIS OF PANCREATIC ANASTOMOTIC INSUFFI

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One of the most serious complications of pancreatoduodenectomy (PD) is a leakage of pancreatic juice from the pancreaticojejunal anastomosis. When performing pancreas-jejunal anastomosis, the pancreatic duct-mucosal suture method or pancreatic duct insertion method was used depending on the degree of pancreatic duct dilatation between October 1983 and December 1990. Minor anastomosic leakage was in 3 out of 11 patients treated with the mucosal suture method. However, patients treated with the duct insertion method had a higher frequency of leakage: minor in 4 out of 28 patients and major in 4. In all patients undergoing PD after January 1991, the mucosal suture method alone was employed. Minor leakage was in 2 out of 31 patients and major in 1. Thus, the occurrence of leakage was reduced in the second part of this series. These results suggest that the risk of leakage can be reduced by using pancreatic duct-jejunal mucosal suture method, even if the pancreatic duct is not dilated.
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