USING THE METHOD OF PANCREATOGASTROSTOMY AT THE STAGE OF RECONSTRUCTION IN PANCREATODUODENECTOMY.

The goal of this study was to analyze the effectiveness of pancreatogastrostomy at the stage of reconstruction by assessing its technical aspects and analysis of the frequency of postoperative complications. The article represents results of the study held with a total of 35 pancreatoduodenectomies performed, followed by reconstruction pancreatogastrostomy. The average patients age was 53.2 years. Men - 13, women - 22. The study non-inclusion criterion was pancreatoduodenectomy with vascular reconstruction. The most common symptom was obstruction jaundice, observed in 29 (82.8%) patients. In 9 (25.7%) cases diabetes mellitus was diagnosed. Eleven (68.7%) patients underwent preoperative endobiliary stenting, five (31.3%) - percutaneous transhepatic biliary drainage. The pancreatoduodenectomy was performed with bilirubinemia not exceeding 100 mcM /l. The most common determined pathology was the pancreatic head carcinoma- 14 (40.2%) cases and the ampulla of Vater carcinoma - 12 (34.2%). The other pathologies were as follows: distal cholangiocarcinoma- 5 (14.3), duodenal cancer - 3 (8.5%) and chronic fibrous-degenerative pancreatitis -1 (2.8%). Biochemical leakage was registered in 6 cases (17.1%), the B grade pancreatic fistula - in 3 cases (8.5%), C grade - in 1 case (2.8%). The postoperative gastroparesis was observed in 5 (14.2%) patients: grade А-3 cases, grade В-2 cases, grade С no cases. The pancreatic stump hemorrhage into the gastric lumen was registered in 4 patients (11.4%). No patient required for relaparotomy, the hemorrhage was arrested by endoscopic argon-plasma coagulation (ERBE 200 D) and conservative treatment. The pancreatogastrostomy method can be used irrelevant of the pancreas parenchyma structure and the main pancreatic duct diameter.