MANAGEMENT OF THE PANCREATIC STUMP FOLLOWING PANCREATICODUODENECTOMY

Pancreaticoduodenectomy is the procedure of choice in patients with pe riampullary and pancreatic cancers. Dramatic improvements in morbidity and mortality rates following pancreaticoduodenectomy have been repor ted in the past 5 years, Consequently, the indications for pancreatico duodenectomy are becoming more liberal, with some authors suggesting i ts use as a palliative procedure in pancreatic cancer and as definitiv e treatment for benign diseases such as chronic pancreatitis. Complica tions are frequently related to the pancreatic stump and can have a fa tal outcome. Several methods of managing the pancreatic stump have bee n described, with variable results. Modifications of standard techniqu es have evolved over time in an effort to reduce the incidence of majo r complications, The results of these methods, the role of perioperati ve adjuncts and the long-term outcome of pancreaticoenteric anastomosi s are reviewed.