The basic characteristics of the two groups, including gender, age, carcinoma location, pancreas texture and ASA classification, are presented in Table
1. Two duodenal interstitialomas were found in the interrupted suture group, and one duodenal carcinoid was found in the continuous suture group. Advanced stage patients with portal vein or inferior vena cava invasion were excluded. There were no significant differences between the two groups in terms of age, gender, tumor location, degree of anemia, pancreatic texture, ASA score, blood loss or total operation time (Table
2). However, the pancreaticoenterostomy time in the continuous suture group was 11.3 ± 1.8 min, which was significantly shorter than the 14.1 ± 2.9 min observed in the interrupted suture group (
p = 0.045). The hospitalization time was also significantly shorter for the continuous suture group (12.3 ± 5.0 d) than the interrupted suture group (24.2 ± 11.6 d,
p = 0.000). Furthermore, the total complications were significantly decreased in the continuous suture group compared with the interrupted suture group (
p = 0.042). There were three cases of death in the interrupted suture group and one case of death in the continuous suture group. Two out of these three deaths occurred after the second laparotomies, owing to hemorrhaging secondary to pancreatic leakage. The other death in the interrupted suture group was due to hemorrhaging without pancreatic leakage. The death in the continuous suture group occurred because of hemorrhaging secondary to pancreatic leakage without a second laparotomy. Regarding pancreatic leakage, according to the criteria of the International Study Group on Pancreatic Fistula (ISGPF), we defined leakage as a drain output of any measurable volume of fluid on or after postoperation day 3 with an amylase activity three times greater than that in the serum [
4]. There were eight cases of pancreatic leakage in the interrupted suture group and two cases in the continuous suture group (Table
3). According to the ISGPF, one case was grade A, three cases were grade B and four cases were grade C in the interrupted suture group, whereas one case was grade B and one case was grade C in the continuous suture group (Table
3). However, neither the incidence (
p = 0.585) nor the severity (
p = 0.292) of pancreatic leakage was significantly different between groups. In the eight cases of pancreatic leakage in the interrupted suture group, two died after the second laparotomies, two exhibited bleeding secondary to leakage and were cured conservatively, and the other four were cured without other secondary injuries. In the continuous suture group, one case of pancreatic leakage died because of a secondary injury of a large hemorrhage, and the other case was cured conservatively.
Table 1
Basic clinic characteristics of the patients
Gender (M/F) | 18/11 | 11/5 | 0.752 |
Age (y) | 67.3 ± 7.4 | 61.2 ± 6.2 | 0.482 |
Location | | | 0.676 |
Jejunum | 14a
| 5b
| |
Lower bile duct | 4 | 4 | |
Ampulla | 8 | 5 | |
Head of pancreas | 3 | 2 | |
Anemia | 86.3 ± 17.5 | 83.9 ± 18.3 | 0.793 |
ASA stage | | | 0.901 |
I | 5 | 2 | |
II | 13 | 8 | |
III | 11 | 6 | |
Pancreas texture | | | 0.868 |
Hard | 7 | 5 | |
Firm | 17 | 7 | |
Soft | 5 | 4 | |
Table 2
The operative characteristics of the patients
Operation time (min) | 260.8 ± 35.6 | 249.5 ± 31.7 | 0.731 |
Pancreaticoenterostomy time (min) | 14.1 ± 2.9 | 11.3 ± 1.8 | 0.045 |
Blood lost (ml) | 465.4 ± 72.3 | 426.1 ± 57.6 | 0.672 |
Hospitalization time (d) | 24.2 ± 11.6 | 12.3 ± 5.0 | 0.000 |
Complicationsa
| | | 0.042 |
Death | 3 | 1b
| |
Pancreatic leakage | 8 | 2 | |
Bleeding | 7 | 2 | |
Pneumonia | 2 | 1 | |
Table 3
Pancreatic leakage classification according to the ISGPF
Pancreatic leakage | 8(27.6 %) | 2(12.5 %) | 0.585 |
Severity classification | | | 0.292 |
Grade A | 1 | 0 | |
Grade B | 4 | 1 | |
Grade C | 3 | 1 | |