Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy - A prospective study

Objective To compare morbidity and mortality rates of stented versus nonste nted pancreaticojejunostomy after partial pancreatoduodenectomy. Background Data Despite a marked reduction in the mortality rate after part ial pancreatoduodenectomy in recent years, leakage of the pancreaticojejuno stomy still occurs in 5% to 25% of patients and remains the major source of complications. Methods The authors compared the morbidity and mortality rates of 85 consec utive patients who had a partial pancreatoduodenectomy with (n = 44) or wit hout (n = 41) temporary stented external drainage of the pancreatic duct be tween 1994 and 1997. Results A pancreatic fistula was diagnosed in 3 of the 44 patients (6.8%) w ith stents versus 12 of the 41 patients (29.3%) without stents. Surgical re intervention was necessary in 1 of the 3 patients with a pancreatic fistula in the stented group and 3 of the 12 patients with a pancreatic fistula in the nonstented group. There were two deaths after surgery, both in the non stented group. The median hospital stay after surgery was 13 days in patien ts with stents and 29 clays in patients without stents. Conclusion In this nonrandomized prospective observational study, temporary external drainage of the pancreatic duct with a PVC tube significantly red uced the leakage rate of the pancreaticojejunostomy as well as the duration of hospital stay after partial pancreatoduodenectomy. Although promising, these observations require confirmation by further studies.