Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?
Hasan Erdem1, Süleyman Çetinkünar1, Mehmet Aziret1, Enver Reyhan2, Alper Sözütek2, Selim Sözen3, Oktay İrkorucu1
1Clinic of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
2Clinic of Gastroenterology Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
3Department of General Surgery, Tekirdağ University School of Medicine, Tekirdağ, Turkey
Objective: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method.
Material and Methods: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb.
Results: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group.
Conclusion: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas.
Keywords: Fistula, pancreatic cancer, pancreaticoduodenectomy
Ethics committee approval was received for this study from the Ethics Committee of Adana Numune Training and Research Hospital.
Written informed consent could not be obtained from the patients because it was a retrospective study.
Concept – H.E., S.Ç., O.İ.; Design – E.R.; Supervision – O.İ., E.R.; Resources – A.S., S.S.; Materials – H.E.; Data Collection and/or Processing – H.E., M.A.; Analysis and/or Interpretation – H.E., A.S., O.İ.; Literature Search – S.S.; Writing Manuscript – H.E.; Critical Review – S.S., O.İ., H.E.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.