Modified Cattell's pancreaticojejunostomy, buttressing for soft pancreases and an isolated biliopancreatic loop are safety measurements that improve outcome after pancreaticoduodenectomy: a pilot study.
BACKGROUND
Pancreatic anastomotic leak is one of the most serious complications following pancreaticoduodenectomy (PD). Various factors have been implicated as contributors to pancreatic anastomotic leaks, the incidence of which has been as high as 28% in some series.


OBJECTIVE
We describe technical modifications to Cattell's technique for pancreaticojejunostomy (PJ), with buttressing of 'soft' pancreases and use of an isolated biliopancreatic loop for reconstruction following a PD.


METHODS
We report our early experience using this technique in 50 patients who underwent PD between May 2002 and June 2006.


RESULTS
There was no mortality in our series. The postoperative morbidity rate was 32% (16/50), with major complications occurring in seven (14%) patients. Pancreatic leak occurred in one patient (2%) and bile leak in one patient (2%). Both patients were managed conservatively.


CONCLUSIONS
Reconstruction after PD using an isolated biliopancreatic loop and modifications to Cattell's technique for PJ, with buttressing of the soft pancreas, can be performed with a low risk of pancreatic anastomotic leakage.
Abu Hilal
Mohammed
M
Department of Hepatopancreatobiliary Surgery, St. James's University Hospital, Leeds, UK.
Malik
Hassan Z
HZ
Hamilton-Burke
Werebena
W
Verbeke
Caroline
C
Menon
Krishna V
KV