title: Appraisal of two-staged pancreatoduodenectomy: its technical aspects and outcome.
abstract: OBJECTIVE
  Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy is closely associated with intraabdominal hemorrhage, thus contributing to mortality. Recently, two-staged pancreatoduodenectomy including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy was performed in high-risk patients.
  
  
  METHODS
  The authors reviewed 24 patients who underwent two-staged pancreatoduodenectomy from November 1994 to April 1999.
  
  
  RESULTS
  Oral intake could be instituted on the 6th (mean) postoperative day. In 23 of the 24 patients, the pancreatic juice leakage stopped within a mean of 10 days without any complications. In the remaining 1, the leakage lasted over 4 weeks and intraabdominal bleeding from the gastroduodenal artery occurred. The median interval between pancreatoduodenectomy and the second operation was 124 days (range: 93-323 days). In 15 patients, a stent tube was placed at the site of pancreaticojejunostomy: 1 patient developed acute pancreatitis due to dislocation of the stent tube, in 3, pancreatic juice leakage necessitated exteriorization of the juice, and the remaining 11 recovered uneventfully. In the other 9 patients, the pancreatic juice was exteriorized: 1 patient had leakage and the other 8 recovered uneventfully. Overall, there was no mortality.
  
  
  CONCLUSIONS
  Our two-staged pancreatoduodenectomy is considered to make pancreatoduodenectomy performable safely without any mortality. This procedure is recommended for selected patients, including those who require concomitant major hepatectomy or resection of other organs or who have liver cirrhosis, and may be indicated for patients who have a soft and fragile pancreas or pancreatic trauma.
authors.affiliation: Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. KUBOTA-2SU@h.u-tokyo.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: T
authors.initials: T
authors.lastname: Takayama
authors.forename: Y
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Harihara
authors.forename: W
authors.initials: W
authors.lastname: Kimura
mesh_terms: D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome