Introduction:

Pancreatico–jejunostomy is the work horse of pancreatic surgery. Pancreatic fistula after pancreaticoduodenectomy represents a critical trigger of potentially life–threatening complications and is also associated with markedly prolonged hospitalization. Many arguments have been proposed for the method to anastomose the pancreatic stump with the gastrointestinal tract, such as invagination vs. duct–to–mucosa.

Aims and objectives:

The authors report their experience with a particular end to side duct to mucosa PJ technique, adopted/ modified from original technique described by M. W. Buchler, H. Friess, Department of general surgery, University of Heidelberg, Germany (15). The results of early postoperative outcomes have been evaluated.

Material and methods

Anastomoses were performed by two surgeons trained at Heidelberg University, Germany.  From January 2006– June 2013, 60 patients (34 males & 26 females) underwent an end–to–side duct to mucosa pancreaticojejunostomy using standardized  PJ technique as a part of Whipple procedure. The diseases of the all patients were malignant. 10–12 PDS 4–0 sutures were used for all layers.

Results

Majority of the patients were in 4th –5th decade. Classical and pylorus preserving Whipple procedure‘s were done in 38 and 22 patients respectively. Preoperative biliary stenting was done in 16 patients. Average time taken for Whipple procedure was 250 minutes and that for pancreatico–jejunostomy was 45 minutes. Only two patients (3.3 %) had minor pancreatic leaks which subsided in 10 days with conservative management. Wound infections developed in 10 patients and LRTI in 11 patients. No peri–operative mortality occurred.

Conclusions

The described technique of end to side duct to mucosa pancreaticojejunostomy is simple, easy to perform with least fistula rate. When performed by experienced hands using a standardized technique and protocol, it is associated with least morbidity and mortality irrespective of the texture of pancreas and size of the pancreatic duct. There was no mortality in our study. Except for wound infection there is no significant difference in total complication rate in patients with pre–op biliary stents.