COMPLICATIONS AFTER PYLORUS-PRESERVING PANCREATICODUODENECTOMY WITH GASTROINTESTINAL RECONSTRUCTION BY THE IMANAGA METHOD

Background: Pylorus-preserving pancreatoduodenectomies (PPPDs) have be en performed for disorders of the pancreatic head and periampullary re gion. The most commonly used reconstructive technique anastomoses the duodenum end-to-side to the jejunum, with pancreatic and biliary anast omoses placed proximally to the end-to-side duodenojejunostomy. In con trast, we ha ve favored PPPD with gastrointestinal reconstruction by t he Imanaga method (PPPD-Imanaga), which consists of end-to-end duodeno jejunostomy, end-to-side pancreatojejunostomy, and choledochojejunosto my, performed in that order, because the PPPD-Imanaga provides a physi ologic mixture of food, pancreatic juice, and bile in the upper portio n of the jejunum. Study Design: To identify their postoperative compli cations, we retrospectively reviewed the cases of 55 patients who unde rwent a PPPD-Imanaga between December 1986 and December 1996. In all c ases, the right gastric artery was divided and the pancreatic duct was sewn directly to a small opening in the jejunal mucosa. Twenty patien ts with malignancy received adjuvant radiotherapy. Results: Five patie nts died without being discharged, including one who died of cancer pr ogression, for a postoperative mortality rate of 9%. These deaths were limited to patients who had received adjuvant radiotherapy, with only two deaths being procedure related. Delayed gastric emptying, pancrea tic leak, and marginal ulcer were observed in 25 (45%), 3 (5%), and 3 (5%) patients, respectively. The delay in gastric emptying was transie nt and resolved spontaneously, with no patients undergoing reoperation . Only one patient required a reoperation, for the control of intraabd ominal bleeding. Conclusions: A PPPD-Imanaga can be performed with acc eptable morbidity and mortality risks. We conclude that the Imanaga me thod is a favorable complement to PPPD. (C) 1998 by the American Colle ge of Surgeons.