Binding pancreatic duct to mucosa anastomosis

/Peng Shuyou

(彭淑牖，Dept Surg，2nd Affil Hosp Zhejiang Univ Col Med，Hangzhou 310009)…∥Chin J Gen Surg.-2011，49(9).-834 ～838

ObjectiveTo study the feasibility of binding pancreatic duct to mucosa anastomosis(BDM)-a comple-mentary procedure to both binding pancreaticojejunostomy and binding pancreaticogastrostomy.Methods(1)Animal experimental study:gastrostomy and jejunostomy were performed on six adult New Zealand rabbits.The gastrostomy and jejunostomy shared a same stent(rubber urethral catheter，silicone tube or plastic infusion tube).Both ends of the stent were placed in gastric and enteric cavity.Purse-string suture was performed around the stent before the jejunum and the stomach were brought together for fixation by few stitches.And to observe whether the purse-string suture around a plastic tube，rubber tube or silicon tube inserted into jejunum and/or stomach can prevent leaking out of the jejunal or gastric content to cause peritonitis.(2)Clinically 7 patients were performed with BDM anastomosis.The procedure was consisted of five steps:preparation of the pancreatic stump;preparation of the jejunum;preparation of the fixing sutures between the pancreatic stump and the jejunum;implementation of the anastomosis;lastly，fixation of the jejunum beside the pancreas stump.Post-operative periodic examination of the blood amylase and the amylase in the abdominal drainage.Pancreatic fistula was classified in to two categories:parenchymal fistula(pancreatic cut surface fistula)and anastomotic leakage.ResultsAnimal experiment did not show any leakage around the plastic tube or silicon tube inserted into jejunum and(or)stomach.There was no anastomotic leak in all the patients.There was transient increase of amylase in two cases，but the volume of drainage did not exceed 50 ml/d and the recovery of the patients was not affected.ConclusionBDM is a simple，safe and easy procedure to perform.It provides the surgeons with a new option in different situations to achieve the most ideal surgical result.18 refs，9 figs，1 tab