title: Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity.
abstract: BACKGROUND
  Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum-preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.
  
  
  METHODS
  Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus-preserving pancreatoduodenectomy (PPPD).
  
  
  RESULTS
  There were no deaths after DPPHE with CBD reinsertion, compared with four (0.9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28.9 and 36 per cent respectively. Fifteen patients (18 per cent) who had DPPHE with CBD reinsertion developed a stricture at the reinsertion site, compared with a long-term stricture rate of 2.3 per cent (ten patients) after DPPHE without CBD reinsertion and 4 per cent (two patients) after PPPD/Whipple resection.
  
  
  CONCLUSIONS
  Although associated with a high incidence of anastomotic stricture, reinsertion of the CBD into the resection cavity as part of DPPHE can be used to preserve duodenal passage and offers an alternative to extended resection for chronic pancreatitis.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Cataldegirmen
authors.forename: D
authors.initials: D
authors.lastname: Bogoevski
authors.forename: O
authors.initials: O
authors.lastname: Mann
authors.forename: J T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: E F
authors.initials: EF
authors.lastname: Yekebas
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012092:Replantation / Q000379:methods; D016896:Treatment Outcome