A NEW TECHNIQUE FOR PANCREATICOGASTROINTESTINAL ANASTOMOSIS WITHOUT SUTURING THE PANCREATIC PARENCHYMA

BACKGROUND: In an attempt to lessen the incidence of pancreatic fistul a and the disruption of pancreatic anastomosis after pancreatoduodenec tomy, we have developed a new technique for pancreaticogastroin-testin al anastomosis that consists of pancreatectomy using the ultrasonic di ssector and implantation of the pancreatic duct into the gastrointesti nal tract without suturing the pancreatic parenchyma. The purpose of t his study is to evaluate the safety and reliability of this new techni que in a canine model of pancreaticogastrostomy and pancreaticoduodeno stomy using 10 beagle dogs. STUDY DESIGN: Canine pancreas was resected using the ultrasonic dissector. In the distal pancreas, a 1-cm long s tump of the main pancreatic duct was freed and the other smaller pancr eatic ducts were skeletonized and securely ligated. The main pancreati c duct was implanted into the stomach or the duodenum and fixed to the seromuscular layer with purse-string sutures without suturing the pan creatic parenchyma. RESULTS: There was no anastomotic leakage, signs o f peritonitis, or abscess formation, and the pancreas was grossly norm al in appearance seven days after operation. Histologic examination of the specimens harvested 30 days after operation revealed good connect ive tissue union between the pancreas and the gastric or duodenal wall , and good mucosal continuity between the pancreatic duct and the stom ach or duodenum. CONCLUSIONS: This new technique is simple, safe, and reliable, and is recommended as an alternative method for restoring pa ncreaticogastrointestinal continuity after pancreatoduodenectomy.