PANCREATICOJEJUNOSTOMY VERSUS CONTROLLED PANCREATICOCUTANEOUS FISTULAIN PANCREATICODUODENECTOMY FOR PERIAMPULLARY CARCINOMA

BACKGROUND: Anastomotic leak of the pancreaticojejunostomy is a major cause of morbidity and mortality following pancreaticoduodenectomy, Re ports have described a large variety of techniques for performing this anastomosis and managing the pancreatic stump, In an attempt to obvia te the pancreaticojejunostomy, we prospectively studied the technique of ligating the pancreatic duct and using external drains to create a temporary controlled pancreaticocutaneous fistula. PATIENTS AND METHOD S:Thirty-five consecutive patients who were to undergo pancreaticoduod enectomy for periampullary carcinoma were prospectively randomized to one of two groups: pancreaticojejunostomy (PJ) (n = 18) or controlled pancreaticocutaneous fistula (CPF) (n = 17), The groups were well matc hed for age, sex, coexisting medical illnesses, type of tumor, and pre operative condition, Except for the management of the pancreatic remna nt, all patients in both groups underwent an identical procedure, Majo r morbidity, length of hospitalization, durationn of the controlled pa ncreatic fistula, and mortality were analyzed over a mean follow-up in terval of 26 months (range 5 months to 7.5 years), RESULTS: The CPF gr oup experienced lower overall operative morbidity rates than the PJ gr oup (24% versus 56%, P <0.01), Two patients (11%) in the PJ group and none in the CPF group died (P = NS), Half the morbidity in the PJ grou p and both mortalities were related to anastomotic leak, The CPF and P J groups left the hospital after mean stays of 26.4 and 42.2 days resp ectively (P <0.01), CONCLUSIONS: Compared to pancreaticojejunal anasto mosis, creation of a temporary controlled pancreaticocutaneous fistula in patients who undergo pancreaticoduodenectomy for periampullary mal ignancy has no appreciable risk, It is associated with reduced morbidi ty and shorter length of hospitalization.