{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:04:59Z","timestamp":1784613899192,"version":"3.55.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric pancreatic surgery is challenging due to soft pancreatic texture and small main pancreatic duct (MPD) diameter, both risk factors for postoperative pancreatic fistula (POPF). The modified stent-free Chen's U-suture technique, a continuous transpancreatic U-shaped invagination pancreaticojejunostomy without stenting, has shown low clinically relevant POPF (CR-POPF) rates in adults. This study evaluates its safety and feasibility in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From July 2018 to November 2025, five children (2 males, 3 females; aged 4.3\u201310.1 years) underwent pancreatic resection with the modified stent-free Chen's U-suture technique (no MPD stent placement). Diagnoses included pancreatic head solid pseudopapillary neoplasm (SPN,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092, one with jaundice), body SPN (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), grade III trauma (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and complex iatrogenic injury (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091). The primary endpoint was POPF rate (ISGPS 2016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All procedures were successful. Median operative time was 5\u2005h (range 3\u20138); mean pancreaticojejunostomy time 17.8\u2005min (15\u201321); median blood loss 50\u2005mL (20\u2013100). Two patients had transient mild hyperamylasemia (&amp;lt; 2\u00d7upper limit of normal) with imaging showing localized perianastomotic edema\/fluid collection without diffuse parenchymal edema or necrosis, managed conservatively. One patient met the criteria for a biochemical leak; no CR-POPF (0%, 95% CI: 0.0%\u201352.2%) (grade B\/C) occurred. No infection, hemorrhage, reoperation, or readmission occurred. Drains were removed on days 5\u201314 (median, 7 days). At median 25-month follow-up (range 4\u201392), one child required pancreatic enzyme replacement for fat malabsorption 4 years post-surgery; no new diabetes or other malabsorption occurred. One patient had asymptomatic mild distal MPD dilatation (2.9\u2005mm) at 25 months; another had normal MPD shape (2.3\u2005mm) at 4 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The modified stent-free Chen's U-suture technique demonstrates promising feasiblility and safety for pediatric pancreatic head, neck, or body tumor resection, grade III trauma, and complex iatrogenic injuries, achieving a 0% CR-POPF rate in this small cohort (95% CI: 0.0%\u201352.2%) without the need for internal stenting. Transient mild hyperamylasemia with localized perianastomotic inflammatory changes is uncommon and manageable. Long-term pancreatic function is generally preserved, though asymptomatic MPD dilatation may occur.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1890358","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:34:49Z","timestamp":1784612089000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A modified stent-free Chen's U-suture technique in pediatric pancreaticojejunostomy: safety and efficacy"],"prefix":"10.3389","volume":"14","author":[{"given":"Houfang","family":"Kuang","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary and Oncology Surgery, Wuhan Children\u2019s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, 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Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xufei","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Oncology Surgery, Wuhan Children\u2019s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Medical Center, Wuhan Children\u2019s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqiang","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Oncology Surgery, Wuhan Children\u2019s Hospital 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