{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:16:44Z","timestamp":1774631804355,"version":"3.50.1"},"reference-count":16,"publisher":"FapUNIFESP (SciELO)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:p>ABSTRACT   Background : Pancreatic fistula is a major cause of morbidity and mortality after pancreatoduodenectomy. To prevent this complication, many technical procedures have been described.  Aim:  To present a novel technique based on slight modifications of the original Heidelberg technique, as new pancreatojejunostomy technique for reconstruction of pancreatic stump after pancreatoduodenectomy and present initial results.  Method:  The technique was used for patients with soft or hard pancreas and with duct size smaller or larger than 3 mm. The stitches are performed with 5-0 double needle prolene at the 2 o\u2019clock, 4 o\u2019clock, 6 o\u2019clock, 8 o\u2019clock, 10 o\u2019clock, and 12 o\u2019clock, positions, full thickness of the parenchyma. A running suture is performed with 4-0 single needle prolene on the posterior and anterior aspect the pancreatic parenchyma with the jejunal seromuscular layer. A plastic stent, 20 cm long, is inserted into the pancreatic duct and extended into the jejunal lumen. Two previously placed hemostatic sutures on the superior and inferior edges of the remnant pancreatic stump are passed in the jejunal seromuscular layer and tied.   Results :  Seventeen patients underwent pancreatojejunostomy after pancreatoduodenectomy for different causes. None developed grade B or C pancreatic fistula. Biochemical leak according to the new definition (International Study Group on Pancreatic Surgery) was observed in four patients (23.5%). No mortality was observed.   Conclusion :  Early results of this technique confirm that it is simple, reliable, easy to perform, and easy to learn. This technique is useful to reduce the incidence of pancreatic fistula after pancreatoduodenectomy.<\/jats:p>","DOI":"10.1590\/0102-6720201700040008","type":"journal-article","created":{"date-parts":[[2018,1,13]],"date-time":"2018-01-13T22:34:54Z","timestamp":1515882894000},"page":"260-263","source":"Crossref","is-referenced-by-count":15,"title":["MODIFIED HEIDELBERG TECHNIQUE FOR PANCREATIC ANASTOMOSIS"],"prefix":"10.1590","volume":"30","author":[{"given":"Orlando Jorge M","family":"TORRES","sequence":"first","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto C N da Cunha","family":"COSTA","sequence":"additional","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe F Macatr\u00e3o","family":"COSTA","sequence":"additional","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romerito Fonseca","family":"NEIVA","sequence":"additional","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarik Soares","family":"SULEIMAN","sequence":"additional","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ygl\u00e9sio L Moyses S","family":"SOUZA","sequence":"additional","affiliation":[{"name":"Federal University of Maranh\u00e3o,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailesh V","family":"SHRIKHANDE","sequence":"additional","affiliation":[{"name":"Tata Memorial Centre Hospital,  India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"key":"ref1","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After","author":"Bassi C","year":"2016","journal-title":"Surgery"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jamcollsurg.2012.09.002","article-title":"A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy","volume":"216","author":"Callery MP","year":"2013","journal-title":"J Am Coll Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1016\/j.jamcollsurg.2015.08.010","article-title":"End-to-side penetrating-suture pancreaticojejunostomy A novel anastomosis technique","volume":"221","author":"Chen Y","year":"2015","journal-title":"J Am Coll Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S1499-3872(15)60027-3","article-title":"Safer intestinal invagination for a solid pancreatico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct","volume":"15","author":"Giudici F","year":"2016","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jamcollsurg.2009.09.020","article-title":"Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications","volume":"210","author":"Grobmyer SR","year":"2010","journal-title":"J Am Coll Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"2 1 1","DOI":"10.1016\/j.surge.2010.10.011","article-title":"Postoperative pancreatic fistula","volume":"9","author":"Hackert T","year":"2011","journal-title":"The Surgeon"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"39","DOI":"10.14701\/ahbps.2017.21.1.39","article-title":"An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy use of one-step circumferential interrupted sutures","volume":"21","author":"Kim M","year":"2017","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/hpb.12279","article-title":"Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy a meta-analysis of seven randomized controlled trials","volume":"17","author":"Liu FB","year":"2015","journal-title":"HPB"},{"key":"ref9","first-page":"276","article-title":"Techniques for prevention of pancreatic leak after pancreatectomy","volume":"3","author":"Schoellhammer HF","year":"2014","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"1","key":"ref10","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00423-007-0221-2","article-title":"Pancreatic fistula after pancreaticoduodenectomy The impact of a standardized technique of pancreaticojejunostomy","volume":"393","author":"Shrikhande SV","year":"2008","journal-title":"Langenbecks Arch Surg"},{"key":"ref11","first-page":"224","article-title":"Pancreatic anastomosis after pancreaticoduodenectomy how we do it. 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