演題

IS-8-5

The evaluation of new technique for Pancreaticogastrostomy after pancreaticoduodenectomy using twin square wrapping with duct-to-mucosa anastomosis

[演者] 前村 公成:1
[著者] 又木 雄弘:1, 蔵原 弘:1, 盛 真一郎:1, 肥後 直倫:1, 迫田 雅彦:1, 飯野 聡:1, 上野 真一:2, 石神 純也:1, 高尾 尊身:3, 新地 洋之:4, 夏越 祥次:1
1:鹿児島大学消化器・乳腺甲状腺外科, 2:鹿児島大学臨床腫瘍学, 3:鹿児島大学フロンティアサイエンス研究推進センター, 4:鹿児島大学保健学科

Background: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreas stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis (twin square wrapping method) compared to conventional pancreaticogastrostomy which we have used as a standard method using pancreas transfixing method with duct-to-mucosa anastomosis thus far.Methods: Thirty patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and divided into the conventional group (n=20) or the twin square wrapping group (n=10) chronologically. The perioperative factors and the post-operative outcomes were retrospectively analyzed.Results: There was no statistical significant difference between two groups in age, gender, ratio of primary lesion, ratio of malignancy and residual pancreas texture. The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume of the twin square wrapping group were lower than the conventional group, but without statistical significance. No clinically significant pancreatic fistulas were observed in either group. The twin square wrapping group had a significantly lower C-reactive protein level, a reduced incidence of intra-abdominal fluid accumulation as assessed by computed tomography, a shorter duration of drain placement, and a shorter hospital stay compared to the conventional group. Conclusions: The twin square wrapping technique should be considered for reducing pancreatic fistulas by diminishing the post-operative inflammatory response and improving patient outcomes without increasing the operating time.
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