title: Trauma pancreaticoduodenectomy for complex pancreaticoduodenal injury. Delayed reconstruction.
abstract: OBJECTIVE
  To assess the feasibility and safety of the delayed reconstruction approach in patients with complex pancreaticoduodenal injuries.
  
  
  METHODS
  Tertiary care center in Northern India.
  
  
  METHODS
  Five patients with complex pancreaticoduodenal injuries, three following blunt and two following penetrating injury.
  
  
  RESULTS
  All patients underwent a pancreaticoduodenectomy. T-tube drainage of the common bile duct and external tube drainage of the pancreatic duct were established. A wide bore tube drain was left in the right upper abdomen. The postoperative course was uneventful in four patients. One patient died from coagulopathy on the 4th postoperative day. Delayed reconstruction was carried out in four patients. In one patient, a pancreaticojejunal anastomosis could not be performed. The postoperative period was uneventful and no patient had a biliary or a pancreatic leak. All four patients are well on follow-up.
  
  
  CONCLUSIONS
  Delayed reconstruction in complex pancreaticoduodenal injuries is a feasible and viable option as was demonstrated by this study. Controlled external tube drainage of the bile and pancreatic ducts facilitates postoperative care and prevents on-going contamination of the peritoneal cavity with bile and pancreatic juice. Leaving behind the uncinate process shortens the operating time with less blood loss. Planned reconstruction is carried out once the inflammatory process has settled.
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Jai Dev
authors.initials: JD
authors.lastname: Wig
authors.forename: Harsh
authors.initials: H
authors.lastname: Garg