J.Jpn. Surg. Soc.. 83(8): 760-768, 1982

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Original article

HEALING PROCESS AND PATENCY OF PANCREATICO-JEJUNOSTOMY FOLLOWING PANCREATICODUODENECTOMY

The healing process of end-to-side pancreatico-jejunostomy by vertical mattress suture (VMS anastomosis) as a modified method of pancreato-jejunostomy following pancreaticoduodenectomy was compared with end-to-end invaginated anastomosis in the dog. Anastomotic site by VMS anastomosis healed completely in 2 weeks, at which time epitheli of the jejunal mucosa and pancreatic duct were histologically joined. In the case of invaginated method the connection of two epitheli took more than one month, accompanied by mass proliferation of granulation tissue. Clinically, the patency of the pancreatico-jejunostomy of the patients who survived more than 10 months was evaluated by using autopsy specimens (VMS anastomosis 3, other anastomosis 1), by ultrasonography of pancreatic remnant (VMS 9, others 4) and by pancreatic function diagnostant (PFD) (VMS 5, others 2). In the autopsy studies all 3 cases of the pancreatic remnant after VMS anastomosis did not show any progression of fibrosis compared to operative specimens in contrast of one case by conventional method with marked progression of fibrosis. Ultrasonography demonstrated reduction of pancreatic ductal caliber in 4 cases with VMS anastomosis postoperatively and in no VMS case more dilated pancreatic duct was demonstrated, where no remarkable change of the caliber of pancreatic duct was showed in cases after other methods. The mean of PFD value for VMS group (n=4) excepting a case with cancer of the head of pancreas which had been 45% preoperatively, was 74.8±2.8% (other group ; 66.2%). Pancreatico-jejunostomy by VMS is benefical for healing process and anastomotic patency.

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