Clinical Analysis of the New Handling Method of Pancreatic Cut Surface in Pancreatoduodenectomy

Kim, Sung Cheol; Kim, Ki Hun; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Ahn, Chul Soo; Moon, Deok Bog; Chu, Chong Woo; Yang, Hyun Seung; Ha, Tae Yong; Oh, Ki Bong; Cho, Sung Hoon; Lee, Sung Gyu

Abstract

BACKGROUND/AIMS: Pancreatoduodenectomy is a common procedure for benign or malignant periampulary diseases. But the morbidity and mortality of the procedure are usually high. Being related with morbidity and mortality, the most important procedure of pancreatoduodenectomy is how handle the remnant pancreas. We analysed retrospectively the efficiency of the new method for low morbidity and low mortality in handling of the remnant pancreas in the procedures of pancreatoduodenectomy.
METHODS
118 consecutive patients who had undergone a pancreatoduodenectomy and pancreaticojejunostomy performed by one surgeon, between September 1994 and June 1999, were evaluated retrospectively. The cases were analysed by age, sex, pathologic dianosis, operation time, the amount of transfusion during operation, the hospital stay, postoperative complications and state of survival.
RESULTS
The average age of 118 patients was 57.6 years, and the male and female ratio was 1.19:1. The classification by patholoic diagnoses were distal common bile duct cancers (29%), the ampulla of Vater cancers (23%), the pancreas head cancers (14%), the duodenal cancers (1.7%) and the others (32%) including benign diseases. The average operation time was 8 hours 3 minutes, the average amount of transfusion was 0.84 unit and the average hospital stay was 26.1 days. There are 12 (10.2%) postoperative complications. The most were 6(5%) cases of delayed gastric emptying, and the others were 2 (1.7%) cases of leakage of pancreaticojejunostomy, 1 (0.8%) case of ARDS, 1 (0.8%) case of gastroduodenal artery bleeding, 1 (0.8%) case of remnant pancreas bleeding, and 1 (0.8%) case of pseudoaneurysmal bleeding of gastroduodenal artery. The 2 cases of leakage of pancreaticojejunostomy developed at the patients of duodenal cancer and ampulla of Vater cancer. The patient who diagnosed by ampulla of Vater cancer died for sepsis due to leakage of the pancreaticojejunostomy (1/118, 0.8%).
CONCLUSION
We had good results in pancreatoduodenectomy and pancreaticojejunostomy by a new method that protect the anastomotic leakge from pancreaticojejunostomy site. This method include pancreas transection by elctrocoagulation, not doing sutures of remnant pancreas to prevent ischemic change of pancreatic cut surface and complete drainage of pancreatic juice using stent that was inserted at remnant pancreatic duct and externally ligated by vicryl with keeping the lumen.