The European journal of surgery = Acta chirurgica · 1993
Pancreaticoduodenectomy with external drainage of the residual pancreatic duct.
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Schoretsanitis G N, Tsiftsis D D, Tatoulis P A, Gontikakis E T
Аннотация
OBJECTIVE: To describe a new and safe technique for draining the residual pancreatic duct after pancreaticoduodenectomy.
DESIGN: Open study.
SETTING: University Hospital, Herakleion, Crete.
SUBJECTS: Eight patients with histological proved cancer of the periampullary region.
INTERVENTIONS: Pancreaticoduodenectomy (Whipple procedure), after which the remnant of the pancreatic duct was not anastomosed to the jejunum but drained externally through a soft polyethylene tube. All patients received total enteral or parenteral nutrition, plus somatostatin.
MAIN OUTCOME MEASURES: Avoidance of the high morbidity associated with pancreaticoduodenectomy, in particular pancreatic fistula secondary to leakage from the pancreaticojejunal anastomosis.
RESULTS: There was no immediate postoperative mortality or morbidity. The output from the pancreatic remnant decreased progressively, and had ceased in all cases within 20 days; the tube was removed when drainage ceased. Median hospital stay was 24 days (range 20-28). Two patients died after 9 and 11 months, respectively, and the remainder were alive at a median of 26.5 months (range 7-38). Blood glucose concentrations remained within the reference range throughout.
CONCLUSION: The technique of external drainage of the pancreatic remnant can safely be combined with a Whipple procedure, ameliorating the risk of postoperative complications and at the same time preserving pancreatic endocrine function.
DESIGN: Open study.
SETTING: University Hospital, Herakleion, Crete.
SUBJECTS: Eight patients with histological proved cancer of the periampullary region.
INTERVENTIONS: Pancreaticoduodenectomy (Whipple procedure), after which the remnant of the pancreatic duct was not anastomosed to the jejunum but drained externally through a soft polyethylene tube. All patients received total enteral or parenteral nutrition, plus somatostatin.
MAIN OUTCOME MEASURES: Avoidance of the high morbidity associated with pancreaticoduodenectomy, in particular pancreatic fistula secondary to leakage from the pancreaticojejunal anastomosis.
RESULTS: There was no immediate postoperative mortality or morbidity. The output from the pancreatic remnant decreased progressively, and had ceased in all cases within 20 days; the tube was removed when drainage ceased. Median hospital stay was 24 days (range 20-28). Two patients died after 9 and 11 months, respectively, and the remainder were alive at a median of 26.5 months (range 7-38). Blood glucose concentrations remained within the reference range throughout.
CONCLUSION: The technique of external drainage of the pancreatic remnant can safely be combined with a Whipple procedure, ameliorating the risk of postoperative complications and at the same time preserving pancreatic endocrine function.