Clinical Analysis of a Duct-to-Mucosa Pancreatojejunostomy in a Pancreatoduodenectomy.
- Author:
Kuhn Uk LEE
1
;
Sung Won KIM
;
Ki Ho KIM
Author Information
1. Department of Surgery, Seoul National University College of Medicine.
- Publication Type:Original Article
- Keywords:
Duct-to-mucosa;
Pancreatoduodenectomy;
Pancreatojejunostomy
- MeSH:
Cause of Death;
Follow-Up Studies;
Humans;
Ligation;
Medical Records;
Mortality;
Pancreaticoduodenectomy*;
Pancreaticojejunostomy*;
Pancreatitis, Chronic;
Postoperative Care;
Postoperative Complications;
Respiratory Distress Syndrome, Adult;
Retrospective Studies
- From:Journal of the Korean Surgical Society
1999;56(5):715-722
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Pancreatoduodenectomy is a standard operation for benign and malignant lesions of the periampullary area. Even though the complication and the mortality rates have markedly decreased owing to recent developments in surgical techniques and postoperative care, the complication rates still remain high. Especially, pancreatic leakage is the main cause of death today in a pancreatoduodenectomy, so surgical techniques dealing with this problem have emerged as a major issue. The usual techniques used have been the duct ligation method, the duct occlusion method, a pancreatojejunostomy, and a pancreatogastrostomy. However, a recent trend has been to maintain pancreato-enteric continuity. Thus, the authors used a pancreatojejunostomy with the duct-to-mucosa method to decrease the complications. METHODS: The authors retrospectively reviewed the medical records of 56 patients who had undergone a pancreatoduodenectomy between January 1987 and July 1997 by one surgeon. RESULTS: The male-to-female ratio was 1.4:1 and the mean age was 55.5 years (ranging from 25 to 77). A Whipple's operation was done in 44 cases, and a pylorus-preserving pancreatoduodenectomy was done in 12 cases. All the cases used a pancreatojejunostomy with the duct-to-mucosa method. No pancreatic leakage was observed in any of the 56 cases. The immediate postoperative complication rate was 28.6%, and there was one (1.8%) postoperative mortality due to adult respiratory distress syndrome. Six patients complained of minimal exocrine functional abnormality, but only one patient, who had suffered severe chronic pancreatitis preoperatively, routinely now takes a pancreatic enzyme. However, even after long-term follow up, no endocrine insufficiency has been detected. CONCLUSIONS: Through our experience, a pancreatojejunostomy with the duct-to-mucosa method is a secure and reasonable method and can be used for all patients undergoing a pancreatoduodenectomy.
