A NEW TECHNIQUE OF DUODENOJEJUNOSTOMY MAY REDUCE THE RATE OF DELAYED GASTRIC EMPTYING AFTER PYLORUS-PRESERVING PANCREATODUODENECTOMY: THE GROWTH FACTOR TECHNIQUE
Marcel Autran Machado, Fabio F. Makdissi, Marcel C C. Machado*
Hospital 9 de Julho, Sao Paulo, São Paulo, Brazil
Background: Despite various technical modifications, delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. DGE results in longer hospital stay, higher cost, lower quality of life, and delay of adjuvant therapy. We have developed a modified duodenojejunostomy technique to reduce the incidence of DGE. Here we evaluate our 4-year experience with this technique.
Methods: This study evaluated consecutive patients who underwent pylorus-preserving pancreatoduodenectomy using the growth factor technique. It consists of performing a posterior seromuscular running suture with a zigzag stitch that stretches the jejunum and allows future growth of the anastomosis (Fig. 1). This results in a longer jejunal opening. The angles at the edge of the duodenum are cut to accommodate the duodenal opening to the longer jejunum (the growth factor). The anterior seromuscular layer is then performed with interrupted sutures to accommodate the larger anastomosis. These patients were compared with a cohort of patients (n=103) before the introduction of this new technique (control group).
Results: 134 patients underwent pylorus-preserving pancreatoduodenectomy. Delayed gastric emptying occurred in only three patients (2.2%), one grade B and two grade C. Compared with the 103 patients in the control group with standard technique, the incidence of DGE was significantly higher (11.6%; P=0.00318). The median hospital stay was also statistically longer in the control group (P=0.048704).
Conclusions: This study demonstrated that the new technique of duodenojejunostomy can reduce the incidence and severity of DGE and allow earlier hospital discharge. Comparative studies are still needed to confirm these preliminary results.
FIGURE 1. The growth factor technique of duodenojejunostomy
Schematic drawing. Posterior seromuscular running suture with zigzag stretch stitch. The suture is performed by placing a longitudinal suture through the seromuscular layer of the duodenum (A to a'), 1 cm below the pylorus, and another suture along the jejunal axis (B to b').
Intraoperative photograph of the posterior seromuscular stretch suture.
Schematic drawing of the stretched jejunum.
Intraoperative image of the stretched jejunum
Back to 2023 Posters