New method of pancreaticojejunostomy with a fast-absorbable suture material

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.