Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

The Complication Rate according to the Method of Pancreaticojejunostomy after Pancreaticoduodenectomy

췌-십이지장절제술에 있어서 췌-공장문합방법에 따른 합병증 비교

  • Park, Jung-Hun (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine) ;
  • Choi, Young-Il (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine) ;
  • Kim, Yong-Hoon (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine) ;
  • Kang, Koo-Jeong (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine) ;
  • Lim, Tae-Jin (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University School of Medicine)
  • 박정훈 (계명대학교 의과대학 외과학교실) ;
  • 최영일 (계명대학교 의과대학 외과학교실) ;
  • 김용훈 (계명대학교 의과대학 외과학교실) ;
  • 강구정 (계명대학교 의과대학 외과학교실) ;
  • 임태진 (계명대학교 의과대학 외과학교실)
  • Published : 2009.03.25

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Abstract

Purpose: This study was designed to compare and analyze the complication rates of different anastomotic methods of pancreaticojejunostomy after performing pancreaticoduodenectomies by a single surgeon. Methods: From January 2000 to August 2007, 92 patients underwent pancreaticoduodenectomy at a single institution. According to the texture of the pancreas and pancreatic duct size (below or above 3 mm), the type of pancreaticojejunal anastomosis was selected (either duct-to-mucosa pancreaticojejunostomy or end-to-side pancreaticojejunostomy with polyethylene tube). Results: The pathologic diagnosis of the 92 patients included 81 patients with adenocarcinoma, five with chronic pancreatitis and three with GIST that developed in the duodenum. The adenocarcinomas include 33 distal CBD cancers, 18 pancreatic head cancers, 27 Ampulla of Vater cancers and 6 duodenal cancers. The pancreatic fistula rate was not significantly different between the duct-to-mucosa group and the end-to-side pancreaticojejunostomy group (nine of the 43 patients in the duct-to-mucosa group (20.9%) and six of the 46 patients in the tube insertion group (13.0%) (p=0.4). The rate of pancreatic fistula, as classified by three different consecutive periods (period I: 2000-2003; period II: 2004-2005; period III: 2006-2007), was markedly decreased and there were less complications with increasing experience (period I: 33.3%; II: 7.1%; III: 6.4%) (p=0.001). Conclusion: When performing pancreaticojejunostomy, both the duct-to-mucosa method and the tube insertion method were effective in decreasing the complication rate if the appropriate method was selected according to the texture of the pancreas and the size of pancreatic duct. The surgeon's experience and skill can affect the occurrence of pancreatic fistula after pancreaticojejunostomy. Enough experience is the most important factor to decrease the complication rate after pancreaticoduodenectomy.

Keywords

References

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