The advantage of Kakita's method with pancreaticojejunal anastomosis for pancreatic resection.

In 1996, we reported the technical aspects of our new method for end-to-side pancreatojejunostomy (Kakita's method) that we performed in combination with the Whipple procedure without any complications related to failure in the anastomosis. In this chapter, we will introduce our technique in end-to-end style pancreatojejunal anastomosis with fewer anastomotic complications. The purpose of this study was to review Kakita's method with pancreatoduodenectomy. From April 1990 to December 2005, 324 consecutive cases of pancreatoduodenectomy were performed in the Department of Surgery at Kitasato University. In our institute, reconstruction in pancreatoduodenectomy is basically performed according to a modified Child's procedure. Our method is simple and can be applied wherever an end-to-side pancreatojejunal anastomosis is required. It consists of three steps: First, a drainage tube is inserted into the pancreatic duct. The second step, which is the unique aspect of our method, is an attachment of the jejunal wall and the cut surface of the pancreas using a single-layer suture technique. This allows us not only to reduce the number of sutures but also to eliminate some of the complicated manipulations required by other methods. The jejunal wall fully covers the cut surface of the pancreas, leaving no uncovered area between the wall and the pancreas. Third, a direct anastomosis between the pancreatic duct and the mucosal layer of the jejunal loop is applied. In our series, pancreatojejunal anastomotic leakage occurred only in 4 out of 324 patients, which was 1.23%. All patients were successfully treated with conservative therapy using drainage for an extended period postoperatively. The newly devised pancreatojejunostomy in our department is a simple, safe, and reliable procedure with excellent results.