Improvement of surgery of pancreatic head masses

Abstract

The aim of the investigation was to improve the results of pancreatoduodenectomy by applying the algorithm of choice of pancreatodigestive anastomosis (PDA) and two original techniques for pancreatojejunal anastomosis. Materials and Methods. When developing an algorithm to choose PDA we took into consideration the complication risk factors: pancreatic tissue consistency, pancreatic duct diameter, and the conformity of pancreatic and jejunal slice plane sizes. Based on the combination of these factors we distinguished five degrees of preparedness to anastomosis, and determined the optimal degrees for every PDA. Within the framework of the algorithm we used two pancreatojejunal anastomosis techniques: invaginated end-to-end with through U-shaped sutures and end-to-loop with pancreatic stump invagination into an enteric reservoir. Five PDA types were used in 48 patients of the main group, and end-to-end pancreatojejunal anastomosis were used in 52 cases in 58 subjects of the control group. Results. Both groups were comparable by the main complication risk factors: pancreatic tissue consistency and a pancreatic duct diameter. The incidence of PDA dehiscence was 4 cases in the treatment group, and 10 cases in the control group. Neither acute pancreatitis nor lethal outcomes due to technical features of PDA formation were found in the treatment group. In the comparison group there were 6 cases of acute pancreatitis and 3 fatal cases. An original end-to-end pancreatojejunal anastomosis was used according to the algorithm in 10 patients, and end-to-loop — in 14 patients of the treatment group. The developed algorithm enables to choose an optimal way of anastomosis formation depending on morphometric characteristics of anastomosed pancreatic and jejunal stump. Conclusion. A customized approach to PDA selection and the original techniques of anastomosis formation within the framework of the algorithm enable to reduce the number of severe complications and fatal cases after pancreatoduodenectomy.