Subtotal pancreatoduodenectomy: use of a defunctionalized loop for pancreatic stump drainage.

BACKGROUND Since its introduction, pancreaticoduodenal resection for periampullary cancer has undergone numerous modifications. As a result, there has been a dramatic decline in the mortality rate. However, a high morbidity rate, mainly due to pancreatic fistula formation, is still reported. OBJECTIVE To evaluate the results of the use of a defunctionalized jejunal loop in patients undergoing pancreatoduodenectomy to minimize both the frequency and severity of anastomotic leak. SETTING Second Surgical Department, Athens University, Aretaieon Hospital, Athens, Greece. DESIGN A series of retrospective cases from February 1990 to December 1997. PATIENTS One hundred five patients who underwent pancreatoduodenectomy and had the pancreatic stump drained in a defunctionalized jejunal loop. METHODS To avoid problems related to fistula formation due to erosion of the anastomoses from activated pancreatic enzymes, a defunctionalized jejunal loop was constructed and the pancreatic stump was invaginated into the end of this loop. RESULTS Using the defunctionalized jejunal loop, the mean (+/-SD) hospitalization was 7.57+/-1.42 days, the morbidity rate was 11.2%, and the mortality rate was 0.95%. CONCLUSIONS A modification of pancreatoduodenectomy for the treatment of pancreatic cancer resulted in an improvement in the immediate results of subtotal pancreatoduodenectomy. Careful detachment of the posterior surface of the pancreas from the anterior surface of the portal vein and performance of pancreaticojejunal anastomosis to a defunctionalized jejunal loop results in lower mortality and morbidity rates, thus making pancreatoduodenectomy a safe procedure.