title: Is the enteral replacement of externally drained pancreatic juice valuable after pancreatoduodenectomy?
abstract: OBJECTIVE
  External drainage of pancreatic juice using a pancreatic duct stent following pancreatoduodenectomy is widely performed. We hypothesized that the replacement of externally drained pancreatic juice would help to prevent postoperative complications, including pancreatic fistulas.
  
  
  METHODS
  Sixty-four patients who underwent pancreatoduodenectomy between 2006 and 2008 were randomly assigned to either a pancreatic juice non-replacement (NR) or replacement (R) group. Eighteen patients were excluded from the analysis because they had unresectable tumors (n = 4), low pancreatic juice output (<100 ml) (n = 11) or for other reasons (n = 3). A total of 46 patients (NR = 24, R = 22) were included in the final analysis. The volume and amylase levels of externally drained pancreatic juice were analyzed on postoperative days 7 and 14. The incidence of postoperative complications, including pancreatic fistulas and delayed gastric emptying, was also assessed.
  
  
  RESULTS
  The total amylase secretion from the pancreatic tube on postoperative day 7 was significantly higher in the NR group compared with the R group (P = 0.044). The incidence of pancreatic fistulas (>Grade B) was also significantly higher in the NR group (33.3 vs. 9.1 %, P = 0.046).
  
  
  CONCLUSIONS
  In cases for whom external pancreatic juice drainage from a stent is applied following pancreaticojejunostomy, enteral replacement of externally drained pancreatic juice may reduce the incidence of postoperative pancreatic fistula formation.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan, yyoko@med.nagoya-u.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000328:Adult; D000368:Aged; D000681:Amylases / Q000032:analysis; D004322:Drainage / Q000379:methods; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010189:Pancreatic Juice / Q000201:enzymology / Q000378:metabolism / Q000502:physiology; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents; D013997:Time Factors
chemical_list: D000681:Amylases