Pancreatico-jejunal anastomosis with invaginating Jejunal "J"-Loop. Preliminary report of a new technique.

1. Introduction Pancreaticoduodenectomy (PD) represents the standard treat- ment for many pancreatic and biliary malignancies and benign or precancerous diseases. It is burdened with high mortality (about 5%) and morbidity rates (ranging 40e55%) [1]. Pancreatic fistula (PF) is the most dreadful complication occurring to 4% up to 30% of patients after PD (according to the definition used which varies greatly among authors); infectious complications occur in about 34% and intra-abdominal abscess in 14% of PD [1,2]. Pancreaticojejunostomy (PJ) is the most widely performed technique and can be carried out end-to-end or end-to-side. Its exact technique varies according to the surgeons: some connect the Abbreviations: PF, pancreatic fistula; PD, pancreaticoduodenectomy; PJ, pan- creaticojejunostomyl; POD, post-operative day. * Corresponding author. “San Matteo degli Infermi”, AUSL Umbria 2, Via Loreto, 06049 Spoleto, Italy. E-mail address: walterbugiantella@alice.it (W. Bugiantella). http://dx.doi.org/10.1016/j.ijsu.2014.05.046 abstract Introduction: The pancreatic anastomosis is the most demanding step after pancreaticoduodenectomy (PD) and the pancreatic fistula (PF) is the most dreaded complication. Many techniques have been investigated to assess the best way to deal with the pancreatic stump after PD and none of these has shown to be superior in terms of statistically significant reduction of PF rate. We report the preliminary experience of a new technique of pancreaticojejunostomy (PJ). Methods: Fifteen patients underwent PD for neoplasms with end-to-side PJ with dunking jejunal “J”- loop, between July 2011 and March 2014. The data about their post-operative outcomes were analyzed. Results: There were no intra-operative neither post-operative deaths. One patient had a grade A PF (6.7%). Total post-operative complications occurred in 6 patients (40%), major post-operative complica- tions occurred in 3 patients (20%). Conclusion: The new “sandwich” technique for dunking PJ after PD that we describe proved to be easy to perform and sure. It appears to be suitable for a dunking PJ when the diameter of the jejunum is too small than this of the pancreatic stump.