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. 2016 Dec 1;32(4):248-251.
doi: 10.5152/UCD.2016.3174. eCollection 2016.

Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?

Hasan Erdem  1 , Süleyman Çetinkünar  1 , Mehmet Aziret  1 , Enver Reyhan  2 , Alper Sözütek  2 , Selim Sözen  3 , Oktay İrkorucu  1
Affiliations

Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?

Hasan Erdem et al. Ulus Cerrahi Derg. .

Abstract

Objective: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method.

Material and methods: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb.

Results: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group.

Conclusion: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas.

Keywords: Fistula; pancreatic cancer; pancreaticoduodenectomy.

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Conflict of interest statement

No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Classical Roux-en-Y reconstruction
Figure 2
Figure 2
Isolated pancreatic loop reconstruction
See this image and copyright information in PMC

References

    1. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–15. https://doi.org/10.1097/01.sla.0000217673.04165.ea. - DOI - PMC - PubMed
    1. Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S. Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg. 2000;87:423–427. https://doi.org/10.1046/j.1365-2168.2000.01395.x. - DOI - PubMed
    1. Cecka F, Jon B, Subrt Z, Ferko A. Pancreatic fistula - definition, risk factors and treatment options. Rozhl Chir. 2013;92:77–84. - PubMed
    1. Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37:1909–1918. https://doi.org/10.1007/s00268-013-2044-3. - DOI - PubMed
    1. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg. 2007;246:1058–1064. https://doi.org/10.1097/SLA.0b013e31814a6906. - DOI - PubMed