Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Binding Pancreaticojejunostomy Compared with Dunking Pancreaticojejunostomy

Binding 췌공장문합술의 초기 경험 및 Dunking 췌공장문합술과의 비교

  • Kim, Say-June (Department of Surgery, Deajeon St. Mary' Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Dong-Ho (Department of Surgery, Deajeon St. Mary' Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Jeong-Goo (Department of Surgery, Deajeon St. Mary' Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Kwang-Jin (Department of Information Consulting, Mokwon University)
  • 김세준 (가톨릭대학교 의과대학 대전성모병원 외과학교실) ;
  • 이동호 (가톨릭대학교 의과대학 대전성모병원 외과학교실) ;
  • 김정구 (가톨릭대학교 의과대학 대전성모병원 외과학교실) ;
  • 이광진 (목원대학교 정보컨설팅학과)
  • Published : 2009.12.31

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Abstract

Purpose: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. Methods: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. Results: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups ($388{\pm}29$ min vs. $459{\pm}21$ min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, $6.97{\pm}0.41$ vs. $6.10{\pm}0.44$ [p=0.037]; POD3, $6.97{\pm}0.41$ vs. $6.10{\pm}0.44$ [p=0.032]; POD7, $4.69{\pm}0.35$ vs. $3.88{\pm}0.25$ [p=0.034], respectively). Conclusion: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.

Keywords

References

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