PANCREATICODUODENECTOMY WITH RECONSTRUCTION BY ROUX-EN-Y PANCREATICOJEJUNOSTOMY - NO OPERATIVE MORTALITY IN A SERIES OF 25 CASES

Historically, pancreaticojejunostomy has been responsible for frequent and serious technical complications and significant mortality after p ancreaticoduodenectomy. To physiologically isolate this anastomosis fr om the gastrointestinal and biliary anastomoses, I have used Roux-en-Y pancreaticojejunostomy for reconstruction after pancreaticoduodenecto my since 1981. This report is a retrospective review of a consecutive personal series of pancreaticoduodenectomies done between 1981 and 199 1. Twenty-five patients ranging in age from 28 to 80 years had either pylorus-preserving pancreaticoduodenectomy (17 cases), classical Whipp le-type pancreaticoduodenectomy (4 cases), or total pancreatectomy (4 cases). Mean operative time was 6.3 hours, mean estimated blood loss w as 1,068 mL, and mean number of units transfused was 1.6 units. Althou gh 9 patients (36%) had a significant postoperative complication, only 2 (8%) required reoperation. Mean postoperative length of stay was 12 .2 days. There was no clinical evidence of leak from the pancreaticoje junostomy, and there was no in-hospital or 30-day postoperative mortal ity. Five patients (20%) operated on for pancreatic carcinoma survived for 5 years. No patient operated on for pancreatitis has died, though only 50% remain pain free. With reconstruction by Roux-en-Y pancreati cojejunostomy, pancreaticoduodenectomy can be accomplished with accept able morbidity and mortality rates.