title: Pancreatic atrophy relative to external versus internal drainage of the pancreatic duct after pylorus-preserving pancreaticoduodenectomy.
abstract: BACKGROUND
  Atrophy of the pancreatic parenchyma, which occurs frequently after pylorus-preserving pancreaticoduodenectomy (PPPD), is often associated with pancreatic exocrine insufficiency. Many surgeons prefer to insert a drainage tube into the remnant pancreatic duct primarily to prevent pancreatic leakage at the pancreaticojejunostomy (PJ) after PPPD. Drainage methods vary widely but can be roughly classified as internal or external drainage. This study intended to evaluate their effects on pancreatic parenchymal atrophy following PPPD.
  
  
  METHODS
  Fifty-seven patients who underwent PPPD were retrospectively divided into two groups, 28 who underwent external and 29 who underwent internal pancreatic drainage. External drainage tubes were removed 4 weeks after PPPD. The volume of the pancreatic parenchyma was serially measured on abdominal computed tomography (CT) scans before PPPD, as well as 7 days and 3, 6, and 12 months after surgery. Degree of pancreatic parenchymal atrophy was determined by calculating pancreatic volume relative to that on day 7.
  
  
  RESULTS
  Univariate analysis showed that patient sex, age, body mass index, concurrent pancreatitis, pathology, and types of PJ did not significantly affect changes in pancreatic volume following PPPD. The degree of pancreatic volume atrophy did not differ significantly in the external and internal drainage groups. No patient in the external drainage group experienced drainage-related surgical complications. The incidence of PJ leak was comparable in the two groups. Postoperative pancreatic atrophy did not induce new-onset diabetes mellitus at 1 year.
  
  
  CONCLUSIONS
  Both external and internal pancreatic drainage methods showed similar atrophy rate of the pancreatic parenchyma following PPPD.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Gu, Seoul, 138-736, Korea.
authors.forename: Daegwang
authors.initials: D
authors.lastname: Yoo
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deog-Bok
authors.initials: DB
authors.lastname: Moon
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Bo-Hyun
authors.initials: BH
authors.lastname: Jung
authors.forename: Sung-Hwa
authors.initials: SH
authors.lastname: Kang
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000209:etiology; D001284:Atrophy / Q000000981:diagnostic imaging / Q000209:etiology; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D059351:Organ Sparing Treatments; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010183:Pancreatic Ducts; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy; D011708:Pylorus; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed