title: 125 Cases of duodenoduodenostomy in pancreas transplantation: a single-centre experience of an alternative enteric drainage.
abstract: Several exocrine drainage procedures have been successfully developed to perform pancreas transplantation (PT). Retroperitoneal graft placement allows exocrine drainage via direct duodenoduodenostomy (DD). This technique provides easy access for endoscopic surveillance and biopsy. A total of 241 PT procedures were performed in our centre between 2002 and 2012. DD was performed in 125 patients, and duodenojejunostomy (DJ) in 116 patients. We retrospectively compared our experience with these two types of enteric drainage, focusing on graft and patient survivals, as well as postoperative complications. With a mean follow-up of 59 months, both groups demonstrated comparable patient and graft survivals. 14 (11%) of 125 cases in the DD group and 21 (18%) of 116 cases in the DJ group had pancreatic graft loss (P = 0.142). Graft thrombosis [5 (4%) vs. 18 (16%) P = 0.002], anastomotic insufficiency [2 (1.6%) vs. 8 (7%) P = 0.052] and relaparotomy [52 (41%) vs. 56 (48%) P = 0.29] occurred more frequently in the DJ group, whereas gastrointestinal bleeding [14 (11%) vs. 4 (3%) P = 0.026] occurred more often in the DD group. DD is a feasible and safe technique in PT, with no increase in enteric complications. It is equivalent to other established techniques and extends the feasibility of anastomotic sites, especially in recipients who have undergone a second transplantation.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Walter
authors.forename: Martin
authors.initials: M
authors.lastname: Jazra
authors.forename: Stylianos
authors.initials: S
authors.lastname: Kykalos
authors.forename: Petra
authors.initials: P
authors.lastname: Kuehn
authors.forename: Stefan
authors.initials: S
authors.lastname: Michalski
authors.forename: Thomas
authors.initials: T
authors.lastname: Klein
authors.forename: Andreas
authors.initials: A
authors.lastname: Wunsch
authors.forename: Richard
authors.initials: R
authors.lastname: Viebahn
authors.forename: Peter
authors.initials: P
authors.lastname: Schenker
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology; D004322:Drainage / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods* / Q000401:mortality; D010180:Pancreatectomy; D012189:Retrospective Studies
keywords: duodenoduodenostomy; duodenum; enteric drainage; pancreas transplantation
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