Management of the pancreatic remnant in pancreatoduodenectomy.

Of the various methods used for the management of the remaining pancreas in 70 patients who had pancreatoduodenectomy for cancer, pancreatojejunostomy (P/J) was associated with the lowest morbidity and closure of the remnant with the highest. End-to-end and end-to-side P/J were equally satisfactory, the use of stents, however, doubled the morbidity. P/J was particularly safe in the presence of a dilated pancreatic duct. Closure of the remnant caused a very high morbidity regardless if the pancreas was closed with sutures or staples. Despite their differences in morbidity, P/J and closure had the same mortality and approximately the same impact on pancreatic function, exocrine as well as endocrine. The study indicated that although closure of the remnant, as it is practiced today, gives results inferior to those obtained with P/J, with some modification it might offer a simple alternative to P/J in the future.