Pancreaticoduodenectomy with reconstruction by Roux-en-Y pancreaticojejunostomy: no operative mortality in a series of 25 cases.

Historically, pancreaticojejunostomy has been responsible for frequent and serious technical complications and significant mortality after pancreaticoduodenectomy. To physiologically isolate this anastomosis from the gastrointestinal and biliary anastomoses, I have used Roux-en-Y pancreaticojejunostomy for reconstruction after pancreaticoduodenectomy since 1981. This report is a retrospective review of a consecutive personal series of pancreaticoduodenectomies done between 1981 and 1991. Twenty-five patients ranging in age from 28 to 80 years had either pylorus-preserving pancreaticoduodenectomy (17 cases), classical Whipple-type pancreaticoduodenectomy (4 cases), or total pancreatectomy (4 cases). Mean operative time was 6.3 hours, mean estimated blood loss was 1,068 mL, and mean number of units transfused was 1.6 units. Although 9 patients (36%) had a significant postoperative complication, only 2 (8%) required reoperation. Mean postoperative length of stay was 12.2 days. There was no clinical evidence of leak from the pancreaticojejunostomy, and there was no in-hospital or 30-day postoperative mortality. Five patients (20%) operated on for pancreatic carcinoma survived for 5 years. No patient operated on for pancreatitis has died, though only 50% remain pain free. With reconstruction by Roux-en-Y pancreaticojejunostomy, pancreaticoduodenectomy can be accomplished with acceptable morbidity and mortality rates.