title: Technical problems in pancreatoduodenectomy.
abstract: This paper reports on technical problems involved in pancreatoduodenectomy. Twenty cases of periampullary carcinoma underwent pancreatoduodenectomy. Pancreatic fistula developed in five cases: three of these patients recovered using simple drainage and TPN; one underwent a second operation in which a new pancreatico-jejunostomy was performed and another patient died (5% of the series) from sepsis and liver failure. After reviewing various techniques used in performing pancreatico-jejunostomy, it is concluded that the most suitable management of the pancreatic stump seems to be the duct-to mucosa anastomosis. But in cases in which this type of reconstruction is impossible, invagination yields satisfactory results.
mesh_terms: D000328:Adult; D000368:Aged; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008722:Methods; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology