Personal experience of pancreas reconstruction following pancreaticoduodenectomy.
BACKGROUND
This study was designed to evaluate the surgical outcomes of an alternative method of pancreaticojejunostomy and pancreaticogastrostomy according to the size of the remnant pancreatic duct following pancreaticoduodenectomy.


METHODS
Eighty-four patients who underwent pancreaticoduodenectomy by the same surgeon were retrospectively reviewed from February 1997 to December 2004. Pancreaticojejunostomy for large remnant pancreatic ducts (>5 mm in diameter) and pancreaticogastrostomy for smaller remnant pancreatic ducts (<5 mm in diameter) were alternately carried out by the surgeon. Patients' perioperative data were evaluated.


RESULTS
The size of the remnant pancreatic duct was significantly different between the pancreaticojejunostomy and pancreaticogastrostomy groups (7.2 +/- 4.3 mm vs 2.9 +/- 1.6 mm, P < 0.001). Pancreaticojejunostomy was carried out in 27 patients (33.3%) and pancreaticogastrostomy was carried out in 51 patients (66.7%). The mean operation time was 327 +/- 67.4 min and the mean duration of the hospital stay was 25.5 +/- 9.1 days. Pancreatic leakage was found in 10 patients (12.3%) without leading to mortality and was successfully treated by temporary restriction of oral intake and conservative management. None of the patients required an additional surgical procedure for pancreatic leak. Other postoperative complications were unremarkable when compared with previous results. One case of massive bleeding found in the pancreaticogastrostomy group required surgical intervention.


CONCLUSIONS
Pancreaticogastrostomy and pancreaticojejunostomy according to the size of the remnant pancreatic duct can be an alternative strategy to maintain the postoperative rate of pancreatic leak within an acceptable range without hospital mortality related to this complication.
Kang
Chang Moo
CM
Department of Surgery, College of Medicine, Yonsei University, Seoul, Korea.
Kim
Kyung Sik
KS
Choi
Jin Sub
JS
Lee
Woo Jung
WJ
Kim
Byong Ro
BR
D000368:Aged; D001649:Bile Duct Diseases / Q000473:pathology / Q000601:surgery*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome