Jejunal loop drainage versus direct pancreatic duct drainage after pancreatic head resection.
OBJECTIVE
Perioperative mortality after pancreatic head resection has fallen to below 5% in high-volume centers, but dehiscence of the pancreatojejunostomy remains a major concern. Despite various methods of protection, insufficiency rates still range from 6% to 19%. External drainage of pancreatic juice from the anastomotic site has shown promising results in the last decade. We compared the morbidity and mortality of two widely used drainage systems.


METHODS
The subjects were 143 patients who underwent pancreatic head resection, followed by jejunal loop drainage with the top of the drain being placed between the pancreatojejunostomy and hepaticojejunostomy in 89, and by direct drainage of the pancreatic duct in 54.


RESULTS
The median age was similar in both groups. Pancreatic fistula developed in 3 (5%) patients with a pancreatic drain and 6 (7%) with a loop drain. Breakdown of the pancreatojejunostomy occurred in 1 (2%) patient with a pancreatic drain and 2 (2%) with a loop drain. The overall perioperative mortality was 0.7%. The surgical and medical complications and postoperative course were similar in the two groups.


CONCLUSIONS
The choice of drainage system did not impact on the number or severity of postoperative complications or survival, indicating that loop drainage is as safe and effective as direct pancreatic duct drainage.
Jacob
Dietmar A
DA
Department of General, Visceral, and Transplant Surgery, Charité - Universitaetsmedizin Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353 Berlin, Germany.
Bahra
Marcus
M
Langrehr
Jan M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery*; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome