J Korean Surg Soc.  1997 Dec;53(6):885-894.

Morbidity and Mortality of the End to End Pancreaticojejunostomy usign the Stent in Pancreaticoduodenectomy : Experience with 43 Patients

• Kim DH
• Lee MS
• Kim CH
• Song OP
• Cho MS
• Park HJ

Abstract

Although many improvements have been made in surgical technique, as well as preoperative and postoperative care, the pancreaticoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. This study concerns a total of 43 patients that underwent a pancreaticojejunostomy using a polyethylene stent by the Dunking method in a pancreaticoduodenectomy at Soon Chun Hyang University Hospital from January 1990 to December 1996. The results obtained are as follows:1) In our study, there were 13 patients with pancreatic head cancer, 11 patients with ampulla of Vater cancer, 5 patients with distal common bile duct cancer, 4 patients with duodenal cancer, 3 patients with chronic pancreatitis, 3 patients with trauma, 3 patients with a choledochal cyst, 1 patient with stomach cancer. 2) There were 23 men (53.5%) and 20 women (46.5%). 3) Postoperative complications developed in 25 patients (58.1%). Of the complications, bleeding was the most commonly observed, after which, in order of frequency, wound infection, leakage at the anastomotic site, intestinal obstruction, and intraabdominal abscess were also observed. 4) The overall operative mortality was 13.9% (excluding emergency cases, mortality was 7.5 %). Four patients died of intraabdominal or gastrointestinal bleeding, one patient died of pancreatic leakage, and one of hepatic failure. 5) Transfusion during the operation (above 5 pints) was significantly correlated with operative morbidity. Preoperative percutaneous transhepatic biliary drainage (PTBD) with serum bilirubin greater than 10 mg/dl significantly decreased the operative morbidity. 6) A prothrombin time more than 13.9 second, serum albumin less than 3.0 g/dl, and an emergency operation were significantly correlated with operative mortality.

Keyword

Morbidity; Mortality; Dunkong method; Pancreaticojejunostomy; Pancreati-coduodenectomy

MeSH Terms

Abscess
Ampulla of Vater
Bilirubin
Choledochal Cyst
Common Bile Duct
Drainage
Duodenal Neoplasms
Emergencies
Female
Head and Neck Neoplasms
Hemorrhage
Humans
Intestinal Obstruction
Liver Failure
Male
Mortality*
Pancreaticoduodenectomy*
Pancreaticojejunostomy*
Pancreatitis, Chronic
Polyethylene
Postoperative Care
Postoperative Complications
Prothrombin Time
Serum Albumin
Stents*
Stomach Neoplasms
Wound Infection
Bilirubin
Polyethylene
Serum Albumin