Experience with end-to-loop pancreaticoenteroanastomosis in pancreaticoduodenectomy.

BACKGROUND/AIMS: Early results of 151 pancreaticoduodenectomies were retrospectively studied.

METHODOLOGY

Pancreaticoduodenectomy was performed in 129 (85.5%) patients with periampullary carcinoma, in 18 (11.9%) with chronic pancreatitis and in 4 (2.7%) patients with other pathologies. Pancreaticoenteroanastomosis was placed in 125 (82.8%) patients, end-to-loop virsungoenteroanastomosis according to V. Onopriev and A. Manuilov was applied in 79 (52.3%) patients (group I). A routine end-to-side anastomosis (group II) was used in 46 (30.5%) cases; other techniques of the pancreatic stump management were performed in 26 patients.

RESULTS

The lethality rate was 11.3%. It varied depending on the type of pancreaticoduodenectomy completion. Three patients with the end-to-loop virsungoenteroanastomosis died in the early postoperative period, compared with 7 (15.2%) deaths in the group with the end-to-side anastomosis. The incidence of postoperative complications was 32.9% in group I, 52.2% in group II. In group I there were no cases of failure of pancreatoenteroanastomosis, in group II this complication was present in 2 (4.4%) patients. Leakage of the pancreatic secretions into the abdominal cavity was revealed in 4 (5.1%) patients of group I, and in 10 (21.7%) of group II.

CONCLUSIONS

The technique of the end-to-loop virsungoenteroanastomosis allows the improvement of early results of pancreaticoduodenectomy due to reduction in infectious and inflammatory complications.