Isolated loop pancreatic remnant drainage following pancreaticoduodenal resection

Using technology-intensive postoperative critical care, interventional radiology and consequent better management of pancreaticojejunal anastomosis (PJA) leaks, the perioperative mortality of pancreaticoduodenal resection (PDR) at high volume Western centers ranges from 1-5%. Facilities for such sophisticated care are not available in most hospitals in the developing world. We hypothesized that by using an isolated Roux loop for the PJA to minimize the consequences of a leak, it might be feasible to perform PDR with comparable results.

From August 1996 to December 2002, 125 consecutive patients (98 males and 27 females with a mean age of 54 years) with peri-ampullary or pancreatic head carcinomas underwent PDR with the PJA made to an isolated Roux loop of jejunum. A prospectively maintained database was analyzed for perioperative mortality, morbidity, hospital stay and costs.

The perioperative mortality was 7 (5.6%) and morbidity 52 (42%). Pancreatic fistulae developed in 15 (12%) patients and biliary or intestinal fistulae developed in 1(0.8%) patient each. Five (4%) patients underwent relaparotomy. The median hospital stay was 13 days (6-46 days).

Using an isolated Roux loop for PJA, centers with limited resources can perform PDR to achieve perioperative outcomes comparable to those reported from more sophisticated centers.