title: Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure.
abstract: BACKGROUND
  Anastomotic failure at the pancreaticojejunostomy after a Whipple procedure, manifested either as a pancreatic fistula or intraabdominal abscess, is still an unacceptably common postoperative complication.
  
  
  METHODS
  A prospectively collected series of 123 patients underwent a Whipple procedure. During the pancreaticojejunostomy, the blood supply at the cut surface of the pancreas was evaluated, and if deemed inadequate, the pancreas was cut back 1.5 to 2.0 cm to improve the blood supply. The anastomosis was performed under magnification with meticulous technique.
  
  
  RESULTS
  There were 123 Whipple procedures performed. In 47 (38%), the blood supply was considered inadequate and the pancreas was cut back. Postoperatively, there were 2 pancreatic fistulas (1.6%) and 2 intraabdominal abscesses (1.6%). There was 1 (0.8%) postoperative death from aspiration pneumonia.
  
  
  CONCLUSIONS
  Pancreatic fistula, the most serious complication of the Whipple procedure, can be almost entirely eliminated by a technique that combines meticulous attention to placement and tying of sutures under magnification with optimization of blood supply to the anastomosis.
authors.affiliation: Department of Surgery, Washington University, St Louis, MO, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Drebin
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Green
authors.forename: Karen L
authors.initials: KL
authors.lastname: Jones
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.forename: David
authors.initials: D
authors.lastname: Linehan
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D015607:Stents; D013536:Suture Techniques; D017211:Treatment Failure