Isolated Roux Loop duct-to-mucosa pancreaticojejunostomy avoids pancreatic leaks in pancreaticoduodenectomy.
BACKGROUND
Over the last decade the operative mortality associated with pancreaticoduodenectomy (PD) has decreased. Pancreatic anastomotic leaks resulting in pancreatic bed sepsis and fistulae, however, remain a significant cause of both morbidity and mortality. The optimal method of reconstruction to minimise pancreatic leaks is controversial.


OBJECTIVE
To review the experience of Roux loop duct-to-mucosa pancreaticojejunostomy in a consecutive series of patients undergoing pancreatic head resection.


METHODS
Over the 6-year period (1993-1998), 41 patients underwent pancreatic head resections for benign (n = 5) and malignant disease (n = 36). There were 19 males and the median age was 62 years (range 29-83). An isolated Roux loop pancreaticojejunostomy was performed in all cases.


RESULTS
Median duration of surgery was 8 h and the median postoperative stay was 16 days. The mean peri-operative blood transfusion was 2.9 units (SD 1.9). The incidence of major complications was 12% and there was 1 death (2.4%). There were no pancreatic leaks or fistulae.


CONCLUSIONS
The low complication rate and the absence of pancreatic fistulae in this series would suggest that Roux loop duct-to-mucosa pancreatic reconstruction should be more widely adopted.
University Department of Surgery, Royal Free Hospital Hampstead NHS Trust, Royal Free Campus, Royal Free and University College Medical School, London, UK.
Abdaal W
AW
Khan
Anil K
AK
Agarwal
Brian R
BR
Davidson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D010183:Pancreatic Ducts / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D016896:Treatment Outcome