Reconstruction after subtotal duodenopancreatectomy in patients with pancreatic duct, distal bile duct and ampullary carcinoma: further experience with a personal technique.

A total of 142 patients underwent pancreatic resection for malignant (128 patients) or benign (14 patients) pancreatic disease. Of these patients, 111 had subtotal duodenopancreatectomy and are discussed in this paper. Reconstruction in these patients was carried out with a special technique. In this technique, two jejunal loops are used. One for fashioning the gastric anastomosis, the other for fashioning the pancreatic and biliary anastomosis. Two patients died in the first 30 postoperative days. Twenty patients had severe complications necessitating early reoperation. The surviving patients had a good quality of postoperative life. Postoperative sequelae like diabetes, steatorrhea and motility disturbances were easily controllable. On the basis of the results obtained, the reported surgical technique of reconstruction of alimentary continuity after subtotal duodenopancreatectomy can be considered an alternative for the surgical management of some of the patients with malignant or benign pancreatic disease considered eligible for subtotal duodenopancreatectomy.