Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy

Pancreaticoduodenectomy is associated with a high degree of morbidity; the main cause is failure of the pancreatic anastomosis. It is imperative that this is performed safely and is secure. Pancreatic leaks will lead to serious morbidity and even mortality. Here we describe the use of a new surgical triple-layer pancreaticojejunostomy in a group of patients with minimal morbidity.

This is a retrospective review from a prospective database. Fifty-one consecutive patients underwent a pancreaticoduodenectomy (either pylorus-preserving (PPPD) or classical Whipple's) from May 1999 to December 2005 and had the pancreaticojejunostomy reconstructed as described below.

The mean age of the 51 patients was 56.71 +/- 9.0 years; 32 (62.7%) were female and 19 (37.3%) were males. The mean operating time was 368.55 +/- 57.94 min; the average blood loss was 396 +/- 236 ml with 15 patients (29.4%) requiring postoperative blood transfusions. The mean pancreatic duct size was 4.94 +/- 2.6 mm. In terms of pancreatic texture, there were 33 (64.7%) hard pancreas and 18 (35.3%) soft pancreas. PPPD was performed on 28 (54.9%) and the classical Whipple's procedure on 23 (45.1%). Twelve patients had postoperative complications; only 1 patient had a pancreatic fistula which was treated conservatively.

This method is safe and reliable. It can be used for a myriad of pancreas remnants with a wide range of pancreatic duct sizes.