End to side mucomucosal Wirsung jejunostomy after pancreaticoduodenectomy: immediate results and long term follow-up.
OBJECTIVE
Pancreatico-duodenectomy (PD) is nowadays a widely performed operation which still carries a risk of some morbidity and mortality due to leakage of the Pancreatico-jejunostomy. The aim of the present paper is to describe critically the experience of a surgical team with a large number of consecutive non-selective PDs, where the same surgical procedure was adopted in all cases to manage the pancreatic stump.


METHODS
Sixty six Whipple/Child PDs and 4 Traverso-Longmire (Duodenum Preserving PD) were performed between 1974 and 1993, by the same surgical team in our surgical department. The management of the pancreatic stump was always the same: a hand-made end-to-side mucomucosal Wirsung-jejunostomy, completed by a second layer between pancreatic capsula and jejunal sero-muscular wall.


RESULTS
The overall mortality was 7.1% (5 cases). Only one death could be ascribed to pancreatico-jejunostomy related complications (post-operative acute pancreatitis). Specific morbidity was 12.6% (9 cases). Only one complication was related to the Wirsung-jejunostomy (leakage of the anastomosis, treated by a "sleeve" end-to-end pancreato-jejunostomy). Long-term patency of the anastomosis was shown by ERCP.


CONCLUSIONS
Even if this anastomotic technique requires a little more time and attention by the surgeon, we think that the low incidence of pancreatico-jejunal anastomosis related complications represents a validation of the method, and a motivation to adopt this anastomotic technique. The long-term patency of the muco-mucosal Wirsung-jejunostomy is another valid argument that supports this kind of management of the pancreatic stump after PD.
Clinica Chirurgica VI, Policlinico Umberto I, Universita La Sapienza, Roma, Italy.
A
A
D'Amato
C
C
Montesani
M
M
Casagrande
R
R
De Milito
A
A
Pronio
G
G
Ribotta
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009092:Mucous Membrane / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000401:mortality; D016896:Treatment Outcome