An original reconstructive method after pylorus-preserving pancreatoduodenectomy

Abstract

Acute pancreatitis and leakage of pancreaticojejunal anastomosis are the most important causes of operative morbidity and mortality after pancreatoduodenectomy. We have introduced a modified technique for reconstruction that provides a functional exclusion of the pancreatic-jejunostomy in respect of the transit of gastric and biliary secretions. The immediate advantages of this technique are the reduction in the risk of leakage and the possibility of undertaking conservative treatment, in the case that leakage occurs. The preservation of the antral-pyloric unit, according to Traverso and Longmire,¹ increases the functional features of the procedure, by reducing entero-gastric refluxes, and assuring a regulated gastric emptying. We herein present our series of 11 pancreatoduodenectomies (PD) for periampullary neoplasms and chronic pancreatitis. Throughout our series we experienced no cases of operative mortality. However, there was one specific instance of morbidity, consisting of one case of external biliary fistula by micro-dehiscence of the hepaticjejunostomy and which was later resolved by conservative treatment. Our most recent results have produced almost normal findings in terms of gastric secretion, gastric emptying and an absence of dumping syndrome, ulcers and refluxes.