Document Detail


Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function.
MedLine Citation:
PMID:  18200668     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to-mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS: The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain. Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION: A mucosa-to-mucosa pancreatico-jejunostomy is the best choice for anastomotic patency when compared with EEPJ. BPJ can effectively maintain anastomotic patency and preserve pancreatic exocrine function as well as ESPJ.
Authors:
Ming-Dong Bai; Liang-Qun Rong; Lian-Chen Wang; Hai Xu; Rui-Fang Fan; Pei Wang; Xiao-Peng Chen; Liu-Bin Shi; Shu-You Peng
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  14     ISSN:  1007-9327     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-17     Completed Date:  2008-05-08     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  441-7     Citation Subset:  IM    
Affiliation:
Department of General Surgery, The Second Affiliated Hospital, Xuzhou Medical College, Xuzhou, Jiangsu Province, China. bmingdong@163.com
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods*
Animals
Body Weight
Humans
Pancreas, Exocrine* / anatomy & histology,  metabolism,  surgery
Pancreatic Function Tests
Pancreaticojejunostomy / methods*
Postoperative Period*
Random Allocation
Swine
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