[MODIFIED TECHNIC OF THE PANCREATO YEYUNAL ANASTOMOSIS IN THE PROXIMAL PANCREATO DUODENECTOMY]
INTRODUCTION: Dehiscence of pancreaticojejunostomy is the major complication after proximal pancreaticoduodenectomy (PDP) that may lead to other complications and eventually to death.OBJECTIVE: We present a modified dunking pancreaticojejunostomy used for reconstruction after PDP.SURGICAL TECHNIQUE: We first performed a purse-string suture around the cut end of the jejunal limb. The pancreas stump is intussuscepted 4 cm into the jejunum guided by two sutures between the pancreas and the intestine. Then the purse-string suture is tied around the pancreas stump, four interrupted anchoring sutures are added in order to avoid slippage of the jejunum out of the pancreas. External diversion of pancreatic and biliary secretions is achieved by means of a tube jejunostomy or a Kehr tube.MATERIAL AND METHODS: We prospectively studied 59 consecutive patients who underwent PDP at the Instituto de Enfermedades Neopl sicas between 1995 and 1998. This technique was used in all the patients regardless the characteristics of the pancreas.RESULTS: Only one (1.7%) patient developed a dehiscence of the pancreticojejunostomy that healed spontaneously. Post-operative morbidity and mortality rate were 35.6% and 0%, respectively.CONCLUSION: Our modified dunking pancreaticojejunostomy is simple, safe and applicable to all type of pancreas and is our standard technique of reconstruction after PD.
Juan
J
Celis
Francisco
F
Berrospi
Eloy
E
Ruiz
Eduardo
E
Payet