[Anastomotic ulcers after duodenopancreatectomy for carcinoma of the head of the pancreas].

Anastomotic ulceration following partial pancreatoduodenectomy carries a substantial risk of complications. More than 50% of patients have episodes of bleeding and up to 20% die as a direct consequence of peptic complications. In a retrospective study of 88 patients, frequency of ulcer was analysed comparing Whipple-Child reconstruction and partial pancreatoduodenectomy with a Roux-Y gastrojejunostomy. Indication was ductal carcinoma of the pancreas in 80 cases and periampullary carcinoma in eight patients. Roux-Y gastrojejunostomy was performed in 53 cases, Billroth-II anastomosis with enteroanastomosis in 35 patients. Perioperative mortality was 7% (n = 6). Nine cases of anastomotic ulceration were verified after Roux-Y gastrojejunostomy (18%). Three out of five Roux patients with a periampullary carcinoma developed ulcers. After Billroth-II reconstruction anastomotic ulceration was found in only one out of 33 cases (3%). Six ulcers presented with bleeding, anastomotic stenosis occurred in two cases. Three ulcer patients with curatively resected periampullary carcinoma were reoperated. After resection of the Roux limb and truncal vagotomy no recurrence was seen during a follow-up period of 19 to 46 months. Roux-Y gastrojejunostomy carries an increased risk of anastomotic ulceration. The lack of inactivation of pepsin by bile acids has to be discussed as an underlying mechanism.