Roux-en-Y reconstruction after pancreaticoduodenectomy.

HYPOTHESIS Roux-en-Y reconstruction (RYR) is associated with a reduction in morbidity and mortality associated with pancreatic anastomotic failure after pancreaticoduodenectomy compared with conventional loop reconstruction (CLR). DESIGN Retrospective study of patients from 1991 to 2006. SETTING Tertiary care center. PATIENTS Records of patients undergoing CLR (n = 588) and patients undergoing RYR (n = 112) between February 1, 1991, and June 30, 2006, for pancreatic ductal adenocarcinoma at a single institution were retrospectively reviewed and compared. MAIN OUTCOME MEASURES Perioperative outcome and mortality were compared for patients who underwent RYR compared with those who underwent CLR. RESULTS Overall, both groups required a similar rate of postoperative interventional radiology procedures (CLR, 6.8%; RYR, 9.8%; P = .24) and subsequent operations (CLR, 6.9%; RYR, 9.1%; P = .62). No significant difference was found in the rate of overall postoperative mortality (CLR, 2.6%; RYR, 0.9%; P = .49). The overall rate of pancreatic anastomotic failure was 7.2%, and pancreatic anastomotic failure was associated with a 6% mortality rate. Among patients who developed pancreatic anastomotic failure, no significant difference was seen between CLR (n = 32) and RYR (n = 16) in length of hospital stay (18 vs 19 days; P = .98) or postoperative mortality (3 patients [9.4%] vs none [0%]; P = .54). CONCLUSION We found that RYR is not associated with a reduction in morbidity after pancreaticoduodenectomy for pancreatic adenocarcinoma compared with CLR, even among patients who develop pancreatic anastomotic failure.