3rd Edition of Global Conference on Surgery and Anesthesia

September 14-15, 2022 | Online Event

September 14 -15, 2022 | Online Event
GCSA 2019

Using of new double invaginated end to end pancreatojejunostomy with transanastomotic stenting and external pancreatic duct drainage: Preliminary report

Merab Kiladze, Speaker at Surgery Congress
Tbilisi State University, Georgia
Title : Using of new double invaginated end to end pancreatojejunostomy with transanastomotic stenting and external pancreatic duct drainage: Preliminary report


Pancreatoduodenectomy (PD) is the most invasive and complex operative procedure of GI tract surgery most commonly performed for the pancreatic head and periampullary area malignancy with morbidity rate 40-50% and mortality on average 5%. Following the PD the pancreatic anastomosis,which is the most important component of reconstruction, carries the highest risk of leak and cause of morbidity and mortality. The incidence of postoperative pancreatic fistula (POPF) rate is estimated to be 5% to 30% and so, the pancreatic anastomosis is still Achilles heel of pancreatic surgery and achieving a zero percent of POPF rate remains a dream of every pancreatic surgeon. More than 80 different methods of pancreaticoenteric reconstruction have been proposed,illustrating the complexity of surgical techniques as well as the absence of the ideal pancreatic anastomosis. METHODS: Our data from 2013 to 2017 include the last series of 29 cases of PD for 14 pancreatic and 15 ampullary tumors.There were 12 females and 17 males(average age 57,range 43-78 years).The standard classic Whipple procedure was performed at 18 cases and modifiedpylorus-preserving variant(ppPD) – in 11 cases. 28 cases of pancreaticojejunostomy and 1 pancreaticogastrostomy were created.Percutaneous biliary drainage procedure was performed at 18 and dual decompression with the pancreatic duct – at 6 cases. In 23 cases the biliary drainage was used as transanastomotic stent during hepaticojejunostomy and in 5 cases the pancreatic duct drainage was also used as transanastomitic stent at our method of performing the double invaginated pancreatojejunostomy. RESULTS: There was no operative mortality in our series of PD. Three patients developed surgical site infection, 2 - dehiscence of abdominal wound closure and 3 patients experienced pancreatic leak and abscess,which required interventional radiologic and intensive care management. Two patients required reinterventional surgical procedure: 1 case of necrohaemorrhagic pancreatitis and 1- of arrosive bleeding and 5 patients died at follow up period (6 months – 3 years).The main operative time was 5 hours and the median length of stay was 12 days overall.There was no postoperative pancreatic fistula in our last series of PD,where preoperative biliary and pancreatic duct drainage and our modified double invaginated pancreatojejunostomy was performed. The transanastomotic biliary and pancreatic catheters were removed 3-4 weeks after surgery when control X-ray examination revealed complete capacity and leak resistance of both anastomoses without any contrast extravasation. CONCLUSIONS: Based on our limited experience we can conclude,that preoperative percutaneous biliary and pancreatic drainage is feasible, safe, effective and realistic miniinvasive procedure. External biliary and pancreatic duct drainage with a stents can effectively reduce the POPF and overall morbidity rates in patients undergoing pancreatoduodenectomy. Our preliminary results of using the double invaginated pancreatojejunostomy with transanastomotic stent and external pancreatic duct drainage are very encouraging and indicate that this technique is less complicated and time consuming,very safe, simple, easy to perform and also applicable almost to all situations. 


Merab Kiladze M.D.,Ph.D is heading Department of Surgery at Javakhishvili Tbilisi State University and at Georgia-Israel Joint Clinic Gidmedi. He graduated from Tbilisi State Medical Institute, Faculty of General Medicine. Dr.Kiladze accomplished his research and clinical fellowships at the Mayo Clinic,Rochester,USA and National Centers of Surgery and Oncology,Moscow,Russia. Dr.Merab Kiladze is Immediate Past President of Mukhadze Society of Surgeons of Georgia,Fellow of American College of Surgeons, International College of Surgeons and Member of Editorial Board of the Journal Ann.Ital.Chir.(Bologna,Italy). He is also Member of European Association for Endoscopic Surgery and European Society of Surgery. In 1997 he was awarded with a Medal of Honor and in 2001 with a Order of Honor by the President of Georgia.In 199 he was awarded with 2000 Millenium Medal of Honor (ABI,USA). Dr.Merab Kiladze is an expert in general surgery Ministry of Labor, Health and Social Affairs of Georgia and Honorary Citizen of Batumi (Georgia).