Reconstruction of the pancreatic duct after pancreaticoduodenectomy: A modification of the Whipple procedure

Background and Objectives: Pancreaticoduodenectomy is still associated with high morbidity and mortality even though there has been significant progre ss in the field of pancreatic surgery and postoperative follow-up. The panc reatoenteric anastomosis, regardless of the technique used, is a major caus e for both morbidity and mortality after Whipple procedure. To overcome all problems resulting from anastomotic leakage, we used external drainage of the pancreatic duct. Methods: In 24 patients who underwent pancreaticoduodenectomy in our Depart ment from 1986 to 1995, a modification to the standard Whipple procedure wa s performed. Instead of pancreaticoenteric anastomosis, external drainage o f the pancreatic duct remnant was performed. The pancreatic duct was intuba ted with a silastic tube, the external end of which was sutured to the skin . All patients received substitution therapy with pancreatic enzymes. Results: Mortality in our group of patients was 4%. No complications due to the external drainage of the pancreatic duct were reported, while no patie nt developed diabetes mellitus after surgery. Conclusions: External drainage of the pancreatic duct renmant can be used a lternatively to pancreatoenteric anastomosis after pancreatoduodenectomy. T he technique is safe and simple to perform and appears to reduce overall op erative time. It may be an option for patients with significant comorbidity and/or intraoperative hemodynamic instability which mandates expeditious c ompletion of the operation. (C) 2001 Wiley-Liss, Inc.