Extended drainage of the pancreatic duct after pancreaticoduodenectomy

Arch Surg. 2009 Dec;144(12):1163-6. doi: 10.1001/archsurg.2009.127.


Hypothesis: Because of better survival following pancreaticoduodenectomy (PD), patients may develop complications due to PD and not due to malignancy per se. Exocrine insufficiency may be related to pancreatic duct obstruction or strictures attributable to duct-to-mucosa anastomosis, as in pancreaticojejunostomy. We propose a technique of managing a post-PD duct obstruction.

Design: Retrospective review from September 2005 to August 2008.

Setting: Methodist Dallas Medical Center, Dallas, Texas, a referral, high-volume, nonuniversity tertiary care center.

Patients: All patients who underwent surgery for anastomotic pancreaticojejunal stricture.

Main outcome measures: Perioperative outcomes.

Results: All the patients were women and aged 62, 78, and 45 years. Comorbidities were documented in 2 patients. Two patients presented with severe acute abdominal pain and hyperamylasemia while 1 was asymptomatic. Two patients underwent magnetic resonance cholangiopancreatography with secretin stimulation. Endoscopic retrograde cholangiopancreatography was attempted in 1 patient. Operating time was 99 minutes, 158 minutes, and 154 minutes. Estimated blood loss was 250 mL, 400 mL, and 500 mL. A single-layer, side-to-side pancreaticogastrostomy was performed as the drainage procedure in all patients. There was no mortality associated with any of the patients within 30 days. Morbidity was seen only in 1 patient. None of the patients needed a reoperation. The mean length of hospital stay was 9 days. All patients were asymptomatic for pain.

Conclusion: We propose a durable technique for treating pancreatic ductal strictures post-PD that appears to result in superior postoperative outcome.

MeSH terms

  • Aged
  • Cohort Studies
  • Drainage / methods*
  • Exocrine Pancreatic Insufficiency / etiology
  • Exocrine Pancreatic Insufficiency / pathology
  • Exocrine Pancreatic Insufficiency / surgery*
  • Female
  • Humans
  • Middle Aged
  • Pancreatic Ducts / pathology
  • Pancreatic Ducts / surgery*
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticojejunostomy / adverse effects*
  • Retrospective Studies
  • Tissue Adhesions / etiology
  • Tissue Adhesions / pathology
  • Tissue Adhesions / surgery
  • Treatment Outcome