BACKGROUND: Since its introduction, reconstruction after pancreatoduodenectomy has undergone numerous modifications, leading to a dramatic decline in the mortality rate. However, the reported morbidity rate, due mainly to pancreatic leakage, still remains high. METHODS: Between January 1999 and April 2005, 102 consecutive patients underwent pancreatojejunostomy after pancreatoduodenectomy. Patients treated by biliary decompression alone (n = 58) were compared with patients treated by jejunal decompression alone (n = 40). Four patients who underwent both biliary and jejunal decompression were excluded from the study. RESULTS: Patients who underwent jejunal decompression had a significantly lower incidence of overall postoperative complications (P = 0.028), pancreatic leakage (P = 0.009), and infection (P = 0.011) than patients who underwent biliary decompression. Only one patient who underwent biliary decompression died as a direct result of pancreatic leakage. CONCLUSIONS: Discontinuation of biliary decompression with postoperative jejunal decompression using tube jejunostomy may be a good option in patients undergoing pancreatoduodenectomy, because it appears to reduce the incidence of overall postoperative complications, pancreatic leakage, and infection.
BACKGROUND: Since its introduction, reconstruction after pancreatoduodenectomy has undergone numerous modifications, leading to a dramatic decline in the mortality rate. However, the reported morbidity rate, due mainly to pancreatic leakage, still remains high. METHODS: Between January 1999 and April 2005, 102 consecutive patients underwent pancreatojejunostomy after pancreatoduodenectomy. Patients treated by biliary decompression alone (n = 58) were compared with patients treated by jejunal decompression alone (n = 40). Four patients who underwent both biliary and jejunal decompression were excluded from the study. RESULTS:Patients who underwent jejunal decompression had a significantly lower incidence of overall postoperative complications (P = 0.028), pancreatic leakage (P = 0.009), and infection (P = 0.011) than patients who underwent biliary decompression. Only one patient who underwent biliary decompression died as a direct result of pancreatic leakage. CONCLUSIONS: Discontinuation of biliary decompression with postoperative jejunal decompression using tube jejunostomy may be a good option in patients undergoing pancreatoduodenectomy, because it appears to reduce the incidence of overall postoperative complications, pancreatic leakage, and infection.
Authors: C J Yeo; J L Cameron; M M Maher; P K Sauter; M L Zahurak; M A Talamini; K D Lillemoe; H A Pitt Journal: Ann Surg Date: 1995-10 Impact factor: 12.969