Roux-en-Y reconstruction after pancreaticoduodenectomy.
OBJECTIVE
Roux-en-Y reconstruction (RYR) is associated with a reduction in morbidity and mortality associated with pancreatic anastomotic failure after pancreaticoduodenectomy compared with conventional loop reconstruction (CLR).


METHODS
Retrospective study of patients from 1991 to 2006.


METHODS
Tertiary care center.


METHODS
Records of patients undergoing CLR (n = 588) and patients undergoing RYR (n = 112) between February 1, 1991, and June 30, 2006, for pancreatic ductal adenocarcinoma at a single institution were retrospectively reviewed and compared.


METHODS
Perioperative outcome and mortality were compared for patients who underwent RYR compared with those who underwent CLR.


RESULTS
Overall, both groups required a similar rate of postoperative interventional radiology procedures (CLR, 6.8%; RYR, 9.8%; P = .24) and subsequent operations (CLR, 6.9%; RYR, 9.1%; P = .62). No significant difference was found in the rate of overall postoperative mortality (CLR, 2.6%; RYR, 0.9%; P = .49). The overall rate of pancreatic anastomotic failure was 7.2%, and pancreatic anastomotic failure was associated with a 6% mortality rate. Among patients who developed pancreatic anastomotic failure, no significant difference was seen between CLR (n = 32) and RYR (n = 16) in length of hospital stay (18 vs 19 days; P = .98) or postoperative mortality (3 patients [9.4%] vs none [0%]; P = .54).


CONCLUSIONS
We found that RYR is not associated with a reduction in morbidity after pancreaticoduodenectomy for pancreatic adenocarcinoma compared with CLR, even among patients who develop pancreatic anastomotic failure.
Grobmyer
Stephen R
SR
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Hollenbeck
Scott T
ST
Jaques
David P
DP
Jarnagin
William R
WR
DeMatteo
Ronald
R
Coit
Daniel G
DG
Blumgart
Leslie H
LH
Brennan
Murray F
MF
Fong
Yuman
Y
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000401:mortality; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000401:mortality; D012189:Retrospective Studies