Pancreaticoduodenectomy with external drainage of the residual pancreatic duct.

OBJECTIVE

To describe a new and safe technique for draining the residual pancreatic duct after pancreaticoduodenectomy.

DESIGN

Open study.

SETTING

University Hospital, Herakleion, Crete.

SUBJECTS

Eight patients with histological proved cancer of the periampullary region.

INTERVENTIONS

Pancreaticoduodenectomy (Whipple procedure), after which the remnant of the pancreatic duct was not anastomosed to the jejunum but drained externally through a soft polyethylene tube. All patients received total enteral or parenteral nutrition, plus somatostatin.

MAIN OUTCOME MEASURES

Avoidance of the high morbidity associated with pancreaticoduodenectomy, in particular pancreatic fistula secondary to leakage from the pancreaticojejunal anastomosis.

RESULTS

There was no immediate postoperative mortality or morbidity. The output from the pancreatic remnant decreased progressively, and had ceased in all cases within 20 days; the tube was removed when drainage ceased. Median hospital stay was 24 days (range 20-28). Two patients died after 9 and 11 months, respectively, and the remainder were alive at a median of 26.5 months (range 7-38). Blood glucose concentrations remained within the reference range throughout.

CONCLUSION

The technique of external drainage of the pancreatic remnant can safely be combined with a Whipple procedure, ameliorating the risk of postoperative complications and at the same time preserving pancreatic endocrine function.