[Results of defunctionalized jejunal loop after pancreaticoduodenectomy].
BACKGROUND
Anastomotic leak continues to be a common cause of complications after pancreaticoduodenectomy. Numerous surgical techniques have been described to avoid this complication.


OBJECTIVE
We evaluated the use of a defunctionalized jejunal loop for the pancreas after pancreaticoduodenectomy.


METHODS
Between 1991 and 2005, the findings in 80 patients were analyzed in this prospective study of the use of a defunctionalized jejunal loop for the pancreas as a reconstructive procedure following pancreaticoduodenectomy. All the patients were operated on by two surgeons. The following clinical variables were recorded: age, sex, diameter of the main pancreatic duct, pancreas texture, operating time, intraoperative blood transfusion, mean length of hospital stay, and operative mortality. Seven complications were defined: anastomotic leakage (biliary and duodenal), pancreatic fistula, abscess, sepsis, bleeding, delayed gastric emptying, and postoperative pancreatitis. Four different definitions were used for pancreatic fistula.


RESULTS
Of the 80 patients, 16 (20%) developed pancreatic fistula according to at least one of the criteria used. Pancreatic fistula was more frequent in patients with a small duct (33.3%), and soft pancreatic texture (29%), and was the cause of 100% of intraabdominal hemorrhages, 80% of abdominal abscesses, and 60% of mortality. The mean length of hospital stay was 20.6 days and the mortality rate was 6.6% (5/80). During follow-up two patients developed pancreatitis.


CONCLUSIONS
After pancreaticoduodenectomy, reconstruction with a defunctionalized jejunal loop for the pancreas is a safe and effective technique.
Jover
José M
JM
Servicio de Cirugía General y Digestivo. Hospital Universitario de Getafe. Getafe. Madrid. España. josemjover@aecirujanos.es
Carabias
Alberto
A
Fuerte
Sagrario
S
Ríos
Raquel
R
Ortega
Irene
I
Limones
Manuel
M
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D003536:Cystadenocarcinoma / Q000401:mortality / Q000601:surgery*; D003537:Cystadenoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D013997:Time Factors