Abstract: Objective:To investigate the efficacy of double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.
Methods:The retrospective cohort study was adopted. The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People′s Hospital from March 2011 to March 2015 were collected. Of 208 patients, 106 patients undergoing double“U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double“U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group. Observation indicators included (1) surgical effects: anastomosis time, postoperative pancreatic leakage, duration of hospital stay, (2) followup situations. The followup using telephone interview and outpatient examination was performed to detect postoperative longterm complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed by t test. Count data were analyzed using the chisquare test.
Results:(1) Surgical effects: 208 patients underwent successful surgery without occurrence of death. The anastomosis time was (13.0±1.5)minutes in the double“U” group and (20.0±1.6)minutes in the Child group, with a statistically significant difference between the 2 groups (t=4.713, P<0.05). Two patients in the double“U” group were complicated with grade A of pancreatic leakage, including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant. Nine patients in the Child group were complicated with pancreatic leakage, including 6 in grade A, 1 in grade B and 2 in grade C, and there were 6 of 33 patients (4 in grade A, 1 in grade B, 1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A, 1 in grade C) with fibrotic pancreatic remnant. There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (χ²=2.951, 4.994, P<0.05). The duration of postoperative hospital stay was (13.5± 1.2)days in the double“U” group and (15.7±2.6)days in the Child group, with a statistically significant difference (t=1.011, P<0.05). No readmission in the 2 groups occurred. (2) Followup situations: 91 of 106 patients in the double“U” group were followed up for 6-54 months with a median time of 30 months. During the followup, 8 patients were dead, 12 patients didn′t undergo reoperation due to multiple metastases in the liver, lung and greater omentum, 4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis, and other patients had good conditions without the occurrence of diabetes, diarrhea, indigestion and hypopancreatism. Eightyeight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months. During the followup, 10 patients were dead, 11 patients didn′t undergo reoperation due to multiple metastases in the liver, lung and greater omentum, 6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis, and other patients had good conditions without the occurrence of diabetes, diarrhea, indigestion and hypopancreatism.
Conclusion:Double-“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time, incidence of pancreatic leakage and duration of postoperative hospital stay, and it is especially suitable for the patients with normal pancreatic remnant.