Modified Devine exclusion for unresectable pancreatic head carcinoma.
OBJECTIVE
Gastrojejunostomy is generally performed for unresectable pancreatic head carcinoma. However, in the case of conventional gastrojejunostomy, the bypass does not always function effectively.


METHODS
For unresectable pancreatic head carcinoma accompanied by severe duodenal stenosis, conventional gastrojejunostomy was performed in 5 cases, and modified Devine exclusion was performed in 7 cases. There were no significant differences between the groups regarding their backgrounds.


RESULTS
There were no significant differences between the two groups for the average operation time, the days before peroral ingestion and the hospital stay. The state of peroral ingestion showed better results for modified Devine exclusion. The discharge rates were better for modified Devine exclusion, showing a significant difference (P = 0.028). The 50%-survival periods were 65 days and 159 days, respectively. The bleeding from the tumor occurred in 2 patients from the conventional gastrojejunostomy group, but none in modified Devine exclusion group.


CONCLUSIONS
Modified Devine exclusion is a simple and effective technique for unresectable pancreatic head carcinoma.
Kato
K
K
Department of Surgery, Hokkaido Gastroenterological Hospital, Honcho 1-1, Higashiku, Sapporo, 065-0041, Japan.
Morita
T
T
Miyasaka
Y
Y
Fujita
M
M
Kondo
S
S
Katoh
H
H
D000368:Aged; D003251:Constriction, Pathologic; D004386:Duodenum / Q000473:pathology; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*