title: Pancreaticoduodenectomy with external drainage of the pancreatic remnant.
abstract: OBJECTIVE
  Leakage of the pancreaticojejunal anastomosis is a serious complication after pancreaticoduodenectomy. External drainage of the pancreatic remnant is one of several methods for reducing pancreaticojejunal anastomotic leakage or fistula. We investigated complications after pancreaticoduodenectomy with and without external drainage of the pancreatic remnant.
  
  
  METHODS
  Patients who underwent pancreaticoduodenectomy at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from November 1991 to October 2007 were enrolled. Before 2001, no external pancreatic drainage was employed during pancreaticojejunal anastomosis (non-stented group). Since 2001, external drainage of the pancreatic remnant has been routinely performed with a paediatric feeding tube (stented group).
  
  
  RESULTS
  There were 28 patients in the non-stented group and 45 in the stented group. Stented patients had undergone significantly more previous abdominal operations, pylorus preserving pancreaticoduodenectomy, and end to end anastomosis of the pancreatic remnant and jejunal limb. Leakage of the pancreaticojejunal anastomosis or pancreatic fistula, overall complications, and re-laparotomy rate were significantly higher in the non-stented group (leakage or fistula 21.4% vs. 6.7%, overall complications 50% vs. 33.3%, and re-laparotomy 18% vs. 2.2%). The only death was in the non-stented group.
  
  
  CONCLUSIONS
  External drainage of the pancreatic remnant after pancreaticoduodenectomy is an effective method for prevention of pancreaticojejunal anastomosis leakage and other related complications.
authors.affiliation: Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Suvit.s@chula.ac
authors.forename: Suvit
authors.initials: S
authors.lastname: Sriussadaporn
authors.forename: Rattaplee
authors.initials: R
authors.lastname: Pak-Art
authors.forename: Sukanya
authors.initials: S
authors.lastname: Sriussadaporn
authors.forename: Kritaya
authors.initials: K
authors.lastname: Kritayakirana
authors.forename: Supparerk
authors.initials: S
authors.lastname: Prichayudh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D015607:Stents