{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T03:52:49Z","timestamp":1793937169652,"version":"4.8.0"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2009,8,6]],"date-time":"2009-08-06T00:00:00Z","timestamp":1249516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The anatomical status of the pancreatic remnant after a pancreatic head resection varies greatly among patients. The aim of the present study was to improve management of the pancreatic remnant for reducing pancreatic fistula after pancreatic head resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ninety\u2010five consecutive patients who underwent an end\u2010to\u2010side, duct\u2010to\u2010mucosa pancreaticojejunostomy after pancreatic head resection were included in the study. To approximate the pancreatic stump to the jejunum, the transfixing and interrupted suture techniques were used in 51 and 44 patients, respectively. We modified the interrupted suture technique according to the anatomical status of the pancreatic remnant, i.e., the shape of the pancreatic stump and the location of the pancreatic duct.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no operative mortality in this study. Overall, 14 patients (15%) developed a clinically relevant pancreatic fistula. Certain anatomical features, including a small pancreatic duct, a soft, nonfibrotic pancreatic gland, and a pancreatic duct adjacent to the posterior cut edge, were significantly associated with pancreatic fistula. The fistula rate in the interrupted suture group was 7%, lower than that (22%) in the transfixing suture group (<jats:italic>P<\/jats:italic> = 0.036), and it was not influenced by pancreatic anatomy. Multivariate analysis identified a nonfibrotic pancreas (versus fibrotic pancreas; odds ratio [OR] 12.58, 95% CI 1.2\u201323.9; <jats:italic>P<\/jats:italic> = 0.001), a soft pancreas (versus hard pancreas; OR 4.67, CI 1.2\u201351.1; <jats:italic>P<\/jats:italic> = 0.006), and the transfixing suture technique (versus interrupted suture technique; OR 9.91, CI 1.7\u201357.5; <jats:italic>P<\/jats:italic> = 0.003) as significant predictors of clinically relevant pancreatic fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pancreatic anastomosis modified according to the pancreatic anatomy is effective in reducing the risk of pancreatic fistula formation with end\u2010to\u2010side, duct\u2010to\u2010mucosa pancreaticojejunostomy after pancreatic head resection.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-009-0179-z","type":"journal-article","created":{"date-parts":[[2009,8,5]],"date-time":"2009-08-05T14:26:20Z","timestamp":1249482380000},"page":"2166-2176","source":"Crossref","is-referenced-by-count":12,"title":["Anatomy\u2010Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection"],"prefix":"10.1002","volume":"33","author":[{"given":"Yoshitsugu","family":"Tajima","sequence":"first","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamotsu","family":"Kuroki","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noritsugu","family":"Tsuneoka","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiko","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiichiro","family":"Kosaka","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhisa","family":"Takatsuki","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susumu","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Kanematsu","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1\u20107\u20101 Sakamoto 852\u20108501 Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,8,6]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.136.4.391"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2004.09.044"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5047"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.140.9.849"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1992.01420080079012"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1006\/jsre.1996.4974"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199522240\u201000014"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(01)00876-6"},{"key":"e_1_2_6_10_2","first-page":"1124","article-title":"Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium\u2010volume hospital","volume":"49","author":"Fujino Y","year":"2002","journal-title":"Hepato\u2010Gastroenterology"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010001\u20100188\u2010z"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010005\u20100137\u20103"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00311562"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4461"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2005.05.001"},{"key":"e_1_2_6_16_2","first-page":"450","article-title":"Comparison of Wirsung\u2010jejunal duct\u2010to\u2010mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy","volume":"4","author":"Batignani G","year":"2005","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"e_1_2_6_17_2","first-page":"1831","article-title":"Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta\u2010analysis regarding 15 years of literature","volume":"11","author":"Bartoli FG","year":"1991","journal-title":"Anticancer Res"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(01)00829\u20107"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000251708.70219.d2"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1080\/13651820410016598"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00534\u2010003\u20100863\u20106"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010007\u20109388\u20105"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1159\/000075943"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800821205"},{"key":"e_1_2_6_25_2","first-page":"202","article-title":"The risk of pancreaticointestinal anastomosis can be predicted preoperatively","volume":"13","author":"Friess H","year":"1996","journal-title":"Pancreas"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199506000\u201000003"},{"key":"e_1_2_6_27_2","first-page":"1589","volume-title":"Sabiston textbook of surgery: the biological basis of modern surgical practice","author":"Steer ML","year":"2007"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.11.1258"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(01)00696\u20101"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010007\u20100236\u20108"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1072\u20107515(02)01202\u20104"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3180676dc2"},{"key":"e_1_2_6_33_2","doi-asserted-by":"publisher","DOI":"10.1159\/000096244"},{"key":"e_1_2_6_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00534\u2010005\u20101036\u20106"},{"key":"e_1_2_6_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20903"},{"key":"e_1_2_6_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010003\u20100036\u20106"},{"key":"e_1_2_6_37_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.139.3.327"},{"key":"e_1_2_6_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5407"},{"key":"e_1_2_6_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181492c28"},{"key":"e_1_2_6_40_2","first-page":"90","article-title":"Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy","volume":"89","author":"Kurosaki I","year":"2004","journal-title":"Int Surg"},{"key":"e_1_2_6_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010005\u20107900\u20103"},{"key":"e_1_2_6_42_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20193"},{"key":"e_1_2_6_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010007\u20100221\u20102"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-009-0179-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-009-0179-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-009-0179-z","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T03:17:55Z","timestamp":1704943075000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-009-0179-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8,6]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2009,10]]}},"alternative-id":["10.1007\/s00268-009-0179-z"],"URL":"https:\/\/doi.org\/10.1007\/s00268-009-0179-z","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,8,6]]}}}