Isolated Roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks.
There have been approximately 70 reported variations of reconstruction after pancreaticoduodenectomy (PD). The pancreaticojejunal (PJ) anastomosis is the source of most reported morbidity and mortality. In this study, we aimed to identify the anastomotic leak rate in patients undergoing PD for malignant disease using a proximal isolated jejunal pancreatic anastomosis. Sixty-one consecutive patients undergoing PD (26 women and 35 men; age range, 41-79 years, mean age, 62 years). had an identical reconstruction. The PJ anastomosis was performed using the most proximal isolated jejunum in two layers: interrupted 4.0 Prolene was used to achieve mucosal/ductal continuity, and 3.0 Prolene was used for the serosal/parenchymal anastomosis, around an appropriately sized stent. All postoperative complications were recorded. A pancreatic leak was defined as persistent discharge of amylase-rich pancreatic drain fluid. The overall complication rate was 44% (27 of 61, including 15 chest infections, 8 wound infections, and 2 postoperative cardiac arrhythmias). There were 3 deaths (30-day mortality rate, 5%). One patient died after a cerebrovascular accident, one from respiratory failure secondary to pneumonia, and the third of methicillin-resistant Staphylococcus aureus septicemia after small bowel ischemia caused by pressure necrosis from a drain. There were no PJ anastomotic leaks. This method of pancreatojejunostomy has produced a 0% leak rate in this center.
Sutton
Christopher D
CD
Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, Leicester, England United Kingdom.
Garcea
Giuseppe
G
White
Stephen A
SA
O'Leary
Emily
E
Marshall
Leslie-Jane
LJ
Berry
David P
DP
Dennison
Ashley R
AR
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome