Related Experiment Video
Updated: Jul 8, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection
G Cataldegirmen1, D Bogoevski, O Mann
1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
Background:
Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum-preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.
Methods:
Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus-preserving pancreatoduodenectomy (PPPD).
Results:
There were no deaths after DPPHE with CBD reinsertion, compared with four (0.9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28.9 and 36 per cent respectively. Fifteen patients (18 per cent) who had DPPHE with CBD reinsertion developed a stricture at the reinsertion site, compared with a long-term stricture rate of 2.3 per cent (ten patients) after DPPHE without CBD reinsertion and 4 per cent (two patients) after PPPD/Whipple resection.
Conclusion:
Although associated with a high incidence of anastomotic stricture, reinsertion of the CBD into the resection cavity as part of DPPHE can be used to preserve duodenal passage and offers an alternative to extended resection for chronic pancreatitis.
