A new method of pancreaticojejunostomy?

A soft pancreatic texture with a narrow pancreatic ductal size creates a high risk for the development of a pancreatic fistula after pancreaticoduodenectomy, often leading to death. Several methods have been advocated to reduce the occurrence of leakage, but the best technique is still a subject of debate.

Leakage of the pancreaticoenterostomy remains a major cause of postoperative morbidity and mortality after pancreaticoduodenectomy. Many factors have been identified that are associated with an increased incidence of this complication. Among them, a small pancreatic ductal size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage.

A team led by Dr. Kenichi Hakamada from Hirosaki University, Japan, has, however, developed a new method of pancreaticojejunostomy with a fast-absorbable suture material, irradiated polyglactin 910, and a temporary stent tube to overcome the technical difficulties of performing a pancreaticoenterostomy of a soft pancreas with a narrow pancreatic duct.

In the view of the team, the key aspect of this method is the use of an irradiated polyglactin 910 suture and a temporary stent. In this method, complete external drainage of the pancreatic juice is secured for about 2 weeks by approximating the pancreatic duct and the jejunal mucosa with this fast-absorbable suture.

It has also been suggested that the incidence of a pancreatic fistula varies according to the definition. It is, therefore, quite important to use an internationally-accepted definition of pancreatic fistula to compare the different aspects of the new surgical method with the conventional one. By applying the four well-documented definitions strictly, the preliminary results of this novel method were well described by doctors from the Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan. The late surgical and nutritional outcomes were also reported.

Any conclusion for the surgical method needs to await randomization or a good cohort study, but the good early and late outcomes of this simple and easy-to-perform method seem to justify the carrying out of a randomized prospective study to compare this new method with appropriate controls.

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This study is described in a clinical research article to be published in the February 21, 2008 issue of the World Journal of Gastroenterology.

Reference: Hakamada K, Narumi S, Toyoki Y, Nara M, Ishido K, Miura T, Kubo N, Sasaki M. An easier method for performing a ancreaticojejunostomy for the soft pancreas using a fast-absorbable suture. World J Gastroenterol 2008; 14(7): 1091-1096

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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.