Duct To Mucosa Method of Pancreaticojejunostomy after Pancreaticoduodenectomy

Abstract

The management of the remaining distal pancreas constitutes an important step in pancreaticoduodenectomy. Restoration of gastro-intestinal continuity can be achieved either with pancreaticojejunostomy of several forms or with pancreatogastrostomy. The purpose of this study is to determine whether duct-to-mucosa method as pancreaticojejunostomy can be a safer method of restoring pancreaticoenteric continuity after pancreaticoduodenectomy. A total of 38 patients have undergone duct-to-mucosa method between July 1987 and March 1994. Pancreaticoduodenectomy was performed for periampullary cancer (n=29), stomach cancer (n=4), colon cancer (n=1), malignant lymphoma of duodenum (n=2), leiomyosarcoma(n=1) and metastatic breast cancer (n=1) of the duodenum. Conventional Whipple operation was performed in 31 cases and pylorus preserving opeation was performed in 7 cases. Postoperative complications were developed in 14 patients. No pancreatic leakage developed or other complications related to the pancreaticojejunostomy developed. Exocrine insufficiency was in one case who had been suffered from chronic pancreatitis and no evidence of endocrine pancreatic insufficiency has been found during follow-up period. Reoperation was performed in 5 cases to manage the complications which were intestinal obstructions, postoperative bleeding and duodenojejunostomy sit leakage after pylorus-preserving method. In conclusion, duct-to-mucosa method of pancreaticojejunostomy is a safer method of reconstruction after pancreaticoduodenectomy through long-term follow-up results.