Applying transductal invaginational pancreaticojejunostomy to decrease pancreatic leakage after pancreaticoduodenectomy.

Pancreatic leakage after pancreaticoduodenectomy is not fully prevented despite pancreaticojejunostomy or pancreaticogastrostomy being applied. Here, a new type of transductal invaginational pancreaticojejunostomy (TDI) was devised to prevent pancreatic leakage. Briefly, prolene was penetrated from inside the pancreatic duct through the pancreatic stump at ventral and dorsal sides, respectively, and penetrated from the jejunal cavity outwards; so the pancreatic duct was kept patently and pancreaticojejunostomy was fixed by the prolene stitches. From August 2009 to March 2012, 29 patients received TDI with their consent. No pancreatic leakage was found postoperatively. The postoperative complications included 1 instance of biliojejunostomy leakage, 1 abscess and 2 incision infections. Our primary experience of applying TDI suggests that it is a simple and effective technique to prevent pancreatic leakage after pancreatoduodenectomy, especially in those cases with soft pancreas and normal pancreatic duct diameter.