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Operative Technique
December 21, 2009

Extended Drainage of the Pancreatic Duct After Pancreaticoduodenectomy

Author Affiliations

Author Affiliations: Cancer Center (Dr Khithani) and Departments of Upper Gastrointestinal Surgery (Drs Curtis and Jeyarajah) and General Surgery (Dr Dickerman), Methodist Dallas Medical Center, Dallas, Texas.

Arch Surg. 2009;144(12):1163-1166. doi:10.1001/archsurg.2009.127

Hypothesis  Because of better survival following pancreaticoduodenectomy (PD), patients may develop complications due to PD and not due to malignancy per se. Exocrine insufficiency may be related to pancreatic duct obstruction or strictures attributable to duct-to-mucosa anastomosis, as in pancreaticojejunostomy. We propose a technique of managing a post-PD duct obstruction.

Design  Retrospective review from September 2005 to August 2008.

Setting  Methodist Dallas Medical Center, Dallas, Texas, a referral, high-volume, nonuniversity tertiary care center.

Patients  All patients who underwent surgery for anastomotic pancreaticojejunal stricture.

Main Outcome Measures  Perioperative outcomes.

Results  All the patients were women and aged 62, 78, and 45 years. Comorbidities were documented in 2 patients. Two patients presented with severe acute abdominal pain and hyperamylasemia while 1 was asymptomatic. Two patients underwent magnetic resonance cholangiopancreatography with secretin stimulation. Endoscopic retrograde cholangiopancreatography was attempted in 1 patient. Operating time was 99 minutes, 158 minutes, and 154 minutes. Estimated blood loss was 250 mL, 400 mL, and 500 mL. A single-layer, side-to-side pancreaticogastrostomy was performed as the drainage procedure in all patients. There was no mortality associated with any of the patients within 30 days. Morbidity was seen only in 1 patient. None of the patients needed a reoperation. The mean length of hospital stay was 9 days. All patients were asymptomatic for pain.

Conclusion  We propose a durable technique for treating pancreatic ductal strictures post-PD that appears to result in superior postoperative outcome.