Comparative Study Between Duct to Mucosa and Invagination Pancreaticojejunostomy After Pancreaticoduodenectomy: (PJ)
Pancreatic Anastomotic Leak
About this trial
This is an interventional treatment trial for Pancreatic Anastomotic Leak focused on measuring pancreaticoduodenectomy, pancreatic fistula
Eligibility Criteria
Inclusion Criteria:
-Consecutive patients who were treated by pancreaticoduodenectomy
Exclusion Criteria:
- Any patients with locally advanced periampullary tumour, metastases
- Patients received neoadjuvant chemoradiotherapy
- Patients underwent pancreaticogastrostomy (PG)
- Patients with advanced liver cirrhosis (Child B or C)
- Malnutrition
- Coagulopathy
Sites / Locations
- Ayman El Nakeeb
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Duct to mucosa PJ group
Invagination PJ group
Duct to mucosa PJ was performed by a two layer end to side PJ. The pancreatic capsule and jejunal serosa were anastomosed by interrupted silk suture 3/0 to form the outer layer in both the anterior and posterior wall of the anastomosis. Jejunostomy was done matched to the pancreatic duct diameter. The inner layer duct to mucosa was performed in eight to twelve stitches with 5/0 prolene. A pancreatic duct stent was inserted during anastomosis to allow easy and accurate suture placement, ensure adequate pancreatic duct exposure, and protect the opposite wall from being inadvertently held by needles then it was removed at the end of anastomosis.
Invagination PJ was performed as an end to side. The pancreatic capsule and jejunal serosa were anastomosed by interrupted silk suture 3/0 to form the outer layer in both the anterior and posterior wall of the anastomosis. Jejunostomy was done matched to the pancreatic stump diameter. The inner layer was performed with 5/0 prolene between pancreatic parenchyma and mucosa. The duct was taken posteriorly and anteriorly to jejunal mucosa. A pancreatic duct stent was inserted during anastomosis and removed at the end of taking the stitches. Reconstruction was completed by end to side hepaticojejunostomy (retrocolic) and gastrojejunostomy (GJ) (antecolic) end to side manually.