Subtotal pancreatoduodenectomy - Use of a defunctionalized loop for pancreatic stump drainage

Background: Since its introduction, pancreaticoduodenal resection for peria mpullary cancer has undergone numerous modifications. As a result, there ha s been a dramatic decline in the mortality rate. However, a high morbidity rate, mainly due to pancreatic fistula formation, is still reported. Objective: To evaluate the results of the use of a defunctionalized jejunal loop in patients undergoing pancreatoduodenectomy to minimize both the fre quency and severity of anastomotic leak. Setting: Second Surgical Department, Athens University, Aretaieon Hospital, Athens, Greece. Design: A series of retrospective cases from February 1990 to December 1997 . Patients: One hundred five patients who underwent pancreatoduodenectomy and had the pancreatic stump drained in a defunctionalized jejunal loop. Methods: To avoid problems related to fistula formation due to erosion of t he anastomoses from activated pancreatic enzymes, a defunctionalized jejuna l loop was constructed and the pancreatic stump was invaginated into the en d of this loop. Results: Using the defunctionalized jejunal loop, the mean (+/- SD) hospita lization was 7.57 +/- 1.42 days, the morbidity rate was 11.2%, and the mort ality rate was 0.95%. Conclusions: A modification of pancreatoduodenectomy for the treatment of p ancreatic cancer resulted in an improvement in the immediate results of sub total pancreatoduodenectomy. Careful detachment of the posterior surface of the pancreas from the anterior surface of the portal vein and performance of pancreaticojejunal anastomosis to a defunctionalized jejunal loop result s in lower mortality and morbidity rates, thus making pan creatoduodenectom y a safe procedure.