S. Matsusue et al., A PROSPECTIVE ANALYSIS OF THE FACTORS INFLUENCING PANCREATICOJEJUNOSTOMY PERFORMED USING A SINGLE METHOD, IN 100 CONSECUTIVE PANCREATICODUODENECTOMIES, Surgery today, 28(7), 1998, pp. 719-726
The factors influencing the healing process of pancreaticojejunostomy
(P-J) following pancreaticoduodenectomy (PD) are still ill defined, al
lowing the recommendation of various anastomotic methods. We conducted
a prospective study to determine the risk factors influencing the pro
tracted healing of P-J, examining 100 consecutive patients who underwe
nt PD followed by P-J, performed as an end-to-side ''mucosa-to-mucosa'
' anastomosis using vertical mattress sutures (VMS method). Protracted
healing of P-J was classified as either peripancreatic sepsis (PPS),
defined as prolonged suppurative discharge of less than 50 ml a day fr
om the drain beneath the P-J for more than 1 week; or a pancreatic fis
tula (PF), defined as prolonged discharge of more than 50 mi a day wit
h a high amylase content (>1 000 IU) for more than 1 week. There were
80 patients with a malignant neoplasm, and 20 with benign disease. The
overall incidence of healing problems following P-J was 9%, which inc
luded 6 patients (6%) with PPS and 3 (3%) with PF, Apart from an advan
ced age of more than 70 gears, none of the patients' characteristics o
r postoperative complications influenced the healing of P-J, The type
of reconstruction, an anastomotic stent, the duct size, and a ''soft''
pancreas were not risk factors either. In conclusion, no factors, apa
rt from the age or any special problem of an individual patient, influ
enced the dehiscence of P-J when the VMS method was used after PD.