Successful pancreatojejunal anastomosis for pancreatoduodenectomy

A series of 100 patients underwent pancreatoduodenectomy for carcinoma of the head of the pancreas (36 patients), the bile duct (19 patients), the gallbladder (14 patients), the papilla of Vater (13 patients), the duodenum (seven patients), the stomach (seven patients) or the colon (one patient), or for chronic pancreatitis (two patients) and adenomyoma of the bile duct (one patient) between October 1983 and December 1990. The operative morbidity and mortality rates were 27 and 6 percent, respectively, and failure of the pancreatojejunal anastomosis was the most common post-operative complication (16 patients). Anastomotic leakage correlated significantly with the quality of the pancreatic remnant and the preoperative technique used (p < 0.01). The leakage rate in 34 patients with fibrotic pancreatic tissue was 5.8 percent (two of 34) and was significantly less than that in 66 patients with a normal pancreatic remnant (21.2 percent). Forty-seven patients underwent direct anastomosis between the main pancreatic duct and the jejunum, using mucosa to mucosa sutures and a pancreatic duct drain tube as well as a single layer of sutures between the pancreatic tissue and the jejunum. Only two patients had a pancreatic fistula (4.2 percent) and the incidence was significantly less than that in 53 patients who received the usual technique of double-layer sutures between the pancreatic remnant and the jejunum without a direct anastomosis to the main pancreatic duct (26.4 percent, p < 0.01).