Pancreaticoduodenectomy with closing the pancreatic stump vs. standard Whipple's procedure: a non-anastomotic technique.
OBJECTIVE
Pancreaticoduodenectomy is commonly used for the surgical treatment of malignancies of the ampulla of Vater, duodenum, head of pancreas, and distal common bile duct (CBD). Pancreatic fistula and anastomotic leakage are the common fatal complications of the procedure. Management of the remaining stump is the most important part of pancreaticoduodenectomy in preventing fistula and leakage. We describe a non-anastomotic procedure that has fewer complications.


METHODS
Wirsung's duct was ligated with interrupted sutures after pancreaticoduodenectomy. Cut edge of pancreatic stump was then sutured. Drainage of the stump field was performed with a Petzer drain.


RESULTS
Of 6 patients who were studied 3 were men and 3 were woman. The mean age was 59.19 years. There was no pancreatic fistula, anastomotic leakage, significant weight loss, far elevation in serum amylase, pancreatitis and oral intake serious problems within the follow-up months (median=7 months, min=2 months, max=20 months).


CONCLUSIONS
Non-anastomotic options such as this necessitate the use of pancreatic enzyme supplementation, but low rate of complications and simplicity of the procedure make it an operation of choice.
Ayazi
Khosro
K
General Surgery Department, Imam Hossein University Hospital, Shaheed Beheshty University of Medical Sciences, Tehran, Iran. kh_ayazi@hotmail.com
Ayazi
Shahin
S
Davaei
Manouchehr
M
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002277:Carcinoma / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome