The Complication Rate according to the Method of Pancreaticojejunostomy after Pancreaticoduodenectomy.
- Author:
Jung Hun PARK
1
;
Young Il CHOI
;
Yong Hoon KIM
;
Koo Jeong KANG
;
Tae Jin LIM
Author Information
1. Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine,Daegu, 700-712, Korea. kjkang@dsmc.or.kr
- Publication Type:Original Article
- Keywords:
Pancreaticoduodenectomy;
Pancreaticojejunostomy;
Complication;
Fistula
- MeSH:
Adenocarcinoma;
Ampulla of Vater;
Duodenum;
Fistula;
Head;
Humans;
Pancreas;
Pancreatic Ducts;
Pancreatic Fistula;
Pancreaticoduodenectomy;
Pancreaticojejunostomy;
Pancreatitis, Chronic;
Polyethylene
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2009;13(1):42-48
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This study was designed to compare and analyze the complication rates of different anastomotic methods of pancreaticojejunostomy after performing pancreaticoduodenectomies by a single surgeon. METHODS: From January 2000 to August 2007, 92 patients underwent pancreaticoduodenectomy at a single institution. According to the texture of the pancreas and pancreatic duct size (below or above 3 mm), the type of pancreaticojejunal anastomosis was selected (either duct-to-mucosa pancreaticojejunostomy or end-to-side pancreaticojejunostomy with polyethylene tube). RESULTS: The pathologic diagnosis of the 92 patients included 81 patients with adenocarcinoma, five with chronic pancreatitis and three with GIST that developed in the duodenum. The adenocarcinomas include 33 distal CBD cancers, 18 pancreatic head cancers, 27 Ampulla of Vater cancers and 6 duodenal cancers. The pancreatic fistula rate was not significantly different between the duct-to-mucosa group and the end-to-side pancreaticojejunostomy group (nine of the 43 patients in the duct-to-mucosa group (20.9%) and six of the 46 patients in the tube insertion group (13.0%) (p=0.4). The rate of pancreatic fistula, as classified by three different consecutive periods (period I: 2000-2003; period II: 2004-2005; period III: 2006-2007), was markedly decreased and there were less complications with increasing experience (period I: 33.3%; II: 7.1%; III: 6.4%) (p=0.001). CONCLUSION: When performing pancreaticojejunostomy, both the duct-to-mucosa method and the tube insertion method were effective in decreasing the complication rate if the appropriate method was selected according to the texture of the pancreas and the size of pancreatic duct. The surgeon's experience and skill can affect the occurrence of pancreatic fistula after pancreaticojejunostomy. Enough experience is the most important factor to decrease the complication rate after pancreaticoduodenectomy.
