Method of Choice for Pancreatic Enteroanastomosis Formation in Patients with Chronic Pancreatitis and Malignant Neoplasms of Pancreas

Abstract

Introduction. Pancreatic enteroanastomosis formation is a decisive stage of the entire operation, as the frequency of complications leading to death remains high.The aim of the study was to improve the clinical outcomes of surgical interventions on pancreas by choosing the proper technique for pancreatic enteroanastomosis formation.Materials and methods. A retrospective-prospective study was performed in the Center for Surgery of the Liver, Pancreas and Biliary Tracts, Ryazan State Medical University. The retrospective stage included the analysis of 270 operation protocols and case histories of patients undergone pancreatic resection. Based on the analysis, the academic staff of the Department of Hospital Surgery, Ryazan State Medical University, developed a technique for pancreatic jejunoanastomosis via through U-shaped sutures (the modified Blumgart-style pancreaticojejunostomy).The prospective stage included analysis of 98 case histories and operation protocols of patients undergone pancreatic resection. There were 73 patients with chronic pancreatitis and 25 patients with the head of the pancreas cancer. Groups were formed uniformly depending on the etiology.Statistical analysis methods included: multivariate correlation analysis using the contingency coefficient (); Shapiro-Wilk test; Pearson's chi-squared test; one-way ANOVA test and multiple comparison method with Bonferroni correction for Student's t-test.Results. Correlation between the infiltrated pancreas and the frequency of complications - was 0.517.The frequency of anastomosis failure with the PD diameter 3 - was 0.167, with PG3mm - = 0.358.The infiltrated parenchyma of the pancreas and the PD diameter 3 mm affected the incidence of postoperative complications - = 0.387 (PG 3 mm, the incidence of postoperative complications - = 0.254).At the reconstructive stage, patients of group 1 were exposed to pouch-invagination pancreatic enteroanastomosis end-to-side, patients of group 2 were exposed to pancreatic enteroanastomosis using nodular sutures, patients of group 3 were exposed to pancreatic jejunoanastomosis using through U-shaped sutures, the modified Blumgart-style pancreaticojejunostomy. In patients from group 1 complications were observed in 58% of cases, in patients from group 2 complications were observed in 45.4% of cases, in patients from group 3 complications were observed in 20.5% of cases (p=0.010). Pancreatic enteroanastomosis failed in 29% of patients from group 1, and in 21.2% of patients from group 2; in patients from group 3 no pancreatic enteroanastamosis failure was observed (p = 0.003). There were 9.7% of gastrostasis cases in patients from group 1, 9.1% of gastrostasis cases in patients from group 2, 8.8% of gastrostasis cases in patients from group 3 (p = 0.1). Postoperative pancreatitis was observed in 12.9% of patients from group 1, in 9.1% of patients from group 2, in 5.9% of patients from group 3 (p=0.015). Twenty-nine percent of patients from group 1, 18.1% of patients from group 2, 2.9% of patients from group 3 required repeated surgical interventions.Conclusions. In case of through U-shaped sutures application, repeated surgical interventions for pancreatic jejunoanastomosis were performed in 2.9% of cases, the rate of postoperative complications was 20.5%, no anastomosis failure was observed.Pancreatic jejunoanastomosis using through U-shaped sutures has proven to be more effective compared to other pancreatic enteroanastomosis techniques applied in clinical practice. It can be used in educational and pedagogical and research activities in medical universities.