Reconstruction after pancreaticoduodenectomy: isolated Roux loop pancreatic anastomosis

Pancreatic fistula is the most frequent major complication after pancreaticoduodenectomy. Its rate may be related to several risk factors, among which pancreatic anastomotic reconstruction techniques. The study reported here was a prospective, non-randomized study of 38 consecutive patients who underwent pancreaticoduodenectomy from March 2006 to February 2007. Two groups were studied according to the type of treatment of the pancreatic remnant: group 1 (n = 18) in which an isolated Roux loop Wirsung-jejunal end-to-side anastomosis was performed; and group 2 (n = 20) in which a pancreaticojejunostomy was carried out in the same jejunal loop as the biliary and gastric anastomosis. The two groups of patients were compared regarding preoperative characteristics, surgical procedure and postoperative outcome. Postoperative mortality, morbidity and pancreatic fistula in all the patients in the two groups were evaluated in relation to several risk factors. The overall postoperative mortality and morbidity rates were 2.6% (1/38 cases) and 26.3% (10/38 cases), respectively. The pancreatic fistula rate was 13.1% (5 cases). There were no significant differences in postoperative outcome between the two groups. However, both mean and median postoperative postoperative hospital stay were shorter in group 1 than in group 2 (P < 0.001). Postoperative pancreatic fistula was not significantly more frequent in relation to any of the different risk factors. The isolated Roux loop Wirsung-jejunal end-to-side anastomosis after PD is safe, easy to perform and allows the same results of pancreaticojejunostomy in the same jejunal loop of the biliary and gastric anastomosis. Moreover the isolated Roux loop reconstruction allows a significant decrease of the length of postoperative hospital stay.