Pancreatico-duodenal transplantation with enteric exocrine drainage: technical aspects.

When a pancreatic transplant program was initiated in Stockholm in 1974 we elected to use enteric drainage of the pancreatic juice; 103 segmental pancreatic transplantations were performed with this technique. However, in 1988 we began to use pancreatico-duodenal grafts with enteric exocrine drainage and we have now performed 25 such procedures. Here we report the technical aspects of this procedure. The cumbersome pancreatico-enteric anastomosis previously needed for enteric drainage has now been replaced by a simple bowel-to-bowel anastomosis. In the present series, only one graft was lost due to the enteric drainage technique, i.e. because of exocrine leakage. No grafts were lost in thrombosis. In the uremic recipients of combined renal and pancreatic grafts the 1-year actuarial graft survival rate was 86%. Pancreatico-duodenal transplantation with enteric exocrine drainage would, therefore, seem to be a sound surgical procedure which is also physiological and not associated with any long-term sequelae.