Pancreaticoduodenectomy with Roux-Y anastomosis in reconstructing the digestive tract: report of 26 patients.
OBJECTIVE
To explore the way to lower the morbidity and mortality of patients after pancreaticoduodenectomy.


METHODS
Between March 1998 and March 2001, 26 patients with periampullary tumors received pancreaticoduodenectomy (PD) with Roux-Y anastomosis to reconstruct the digestive tract. Of these patients, 6 had ductal cell carcinoma at the head of the pancreas, 8 distal common bile duct carcinoma, 5 ampullar adenocarcinoma of the Vater, 6 duodenal adenocarcinoma, and 1 duodenal malignant lynphoma. A 30-40 cm free vascularized segment of the proximal jejunum was taken and pulled up to the bed of the duodenum for end-to-end pancreaticojejunostomy, end-to-side choledocojejunostomy or side-to-side jejunojejunostomy by a single loop.


RESULTS
The operative mortality was zero. Postoperative intraabdominal hemorrhage occurred in 2 patients, but no leakage during pancreaticojejunostomy or choledocojejunostomy as well as abdominal infection. The patients were discharged from the hospital on the tenth to fourteenth day after operation. Follow-up for 5 to 36 months (mean 21 months) revealed chronic steatorrhea and malnutrition in one patient (3.85%), and good digestive function and normal nutritional status in 25 (96.15%). No bile reflux gastritis, retrograde infection, anastomotic ulcer, and dumping syndrome were observed.


CONCLUSIONS
Our results show that this procedure can effectively reduce the morbidity and mortality of patients after PD.
Ma
You-Gang
YG
Department of Second Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China. 25588@163.com
Li
Xiao-Song
XS
Chen
Han
H
Wu
Meng-Cao
MC
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D000713:Anastomosis, Roux-en-Y; D001650:Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D012189:Retrospective Studies