ANASTOMOTIC ULCERATION FOLLOWING DUODENOP ANCREATECTOMY FOR PANCREATIC-CANCER

Anastomotic ulceration following partial pancreatoduodenectomy carries a substantial risk of complications. More than 50% of patients have e pisodes of bleeding and up to 20% die as a direct consequence of pepti c complications. In a retrospective study of 88 patients, frequency of ulcer was analysed comparing Whipple-Child reconstruction and partial pancreatoduodenectomy with a Roux-Y gastrojejunostomy. Indication was ductal carcinoma of the pancreas in 80 cases and periampullary carcin oma in eight patients. Roux-Y gastrojejunostomy was performed in 53 ca ses, Billroth-II anastomosis with enteroanastomosis in 35 patients. Pe rioperative mortality was 7% (n = 6). Nine cases of anastomotic ulcera tion were verified after Roux-Y gastrojejunostomy (18%). Three out of five Roux patients with a periampullary carcinoma developed ulcers. Af ter Billroth-II reconstruction anastomotic ulceration was found in onl y one out of 33 cases (3%). Six ulcers presented with bleeding, anasto motic stenosis occurred in two cases. Three ulcer patients with curati vely resected periampullary carcinoma were reoperated. After resection of the Roux limb and truncal vagotomy no recurrence was seen during a follow-up period of 19 to 46 months. Roux-Y gastrojejunostomy carries an increased risk of anastomotic ulceration. The lack of inactivation of pepsin by bile acids has to be discussed as an underlying mechanis m.