Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure.
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.
Strasberg
Steven M
SM
Department of Surgery, Washington University, St Louis, MO, USA.
Drebin
Jeffrey A
JA
Mokadam
Nahush A
NA
Green
Douglas W
DW
Jones
Karen L
KL
Ehlers
Justis P
JP
Linehan
David
D
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