Torres Orlando Jorge M, Costa Roberto C N da Cunha, Costa Felipe F Macatrão, Neiva Romerito Fonseca, Suleiman Tarik Soares, Souza Yglésio L Moyses S, Shrikhande Shailesh V
Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil.
Department of Surgical Oncology, Tata Memorial Centre Hospital, Mumbai, India.
Arq Bras Cir Dig. 2017 Oct-Dec;30(4):260-263. doi: 10.1590/0102-6720201700040008.
Pancreatic fistula is a major cause of morbidity and mortality after pancreatoduodenectomy. To prevent this complication, many technical procedures have been described.
To present a novel technique based on slight modifications of the original Heidelberg technique, as new pancreatojejunostomy technique for reconstruction of pancreatic stump after pancreatoduodenectomy and present initial results.
The technique was used for patients with soft or hard pancreas and with duct size smaller or larger than 3 mm. The stitches are performed with 5-0 double needle prolene at the 2 o'clock, 4 o'clock, 6 o'clock, 8 o'clock, 10 o'clock, and 12 o'clock, positions, full thickness of the parenchyma. A running suture is performed with 4-0 single needle prolene on the posterior and anterior aspect the pancreatic parenchyma with the jejunal seromuscular layer. A plastic stent, 20 cm long, is inserted into the pancreatic duct and extended into the jejunal lumen. Two previously placed hemostatic sutures on the superior and inferior edges of the remnant pancreatic stump are passed in the jejunal seromuscular layer and tied.
Seventeen patients underwent pancreatojejunostomy after pancreatoduodenectomy for different causes. None developed grade B or C pancreatic fistula. Biochemical leak according to the new definition (International Study Group on Pancreatic Surgery) was observed in four patients (23.5%). No mortality was observed.
Early results of this technique confirm that it is simple, reliable, easy to perform, and easy to learn. This technique is useful to reduce the incidence of pancreatic fistula after pancreatoduodenectomy.
胰瘘是胰十二指肠切除术后发病和死亡的主要原因。为预防这一并发症，已描述了许多技术操作。
介绍一种基于对原始海德堡技术稍加修改的新技术，作为胰十二指肠切除术后重建胰腺残端的新型胰肠吻合技术，并展示初步结果。
该技术用于胰腺质地软硬不同、胰管直径小于或大于3mm的患者。在胰腺实质全层的2点、4点、6点、8点、10点和12点位置用5-0双针普理灵缝线进行缝合。用4-0单针普理灵缝线在胰腺实质的前后表面与空肠浆肌层进行连续缝合。将一根20cm长的塑料支架插入胰管并延伸至空肠腔内。将先前在残余胰腺残端上下边缘放置的两根止血缝线穿过空肠浆肌层并打结。
17例患者因不同原因在胰十二指肠切除术后接受了胰肠吻合术。无一例发生B级或C级胰瘘。根据新定义（国际胰腺手术研究组），4例患者（23.5%）出现生化漏。未观察到死亡病例。
该技术的早期结果证实其简单、可靠、易于操作且易于学习。该技术有助于降低胰十二指肠切除术后胰瘘的发生率。
