Biliodigestive anastomosis with circular mechanical device after pancreatoduodenectomy: our experience

The authors describe the technique to perform a mechanical biliodigestive anastomosis after pancreatoduodenectomy that could be able to reduce the time of surgical intervention and the major systemic postoperative complication especially in elderly patients. Pancreaticoduodenectomy (PD) is considered to be the most effective procedure for the treatment of tumors of the pancreatic head and periampullary tumors. Postoperative morbidity remains high, reaching 40-50% in some series. Leakage and stricture of hepaticojejunal anastomosis have a special significance and occur in 2.5-5% of cases. The usefulness of mechanical staplers is well established in gastric and colorectal surgery, but their use in creating biliodigestive anastomosis is still a very controversial application. In the last 2 years (Nov 2008-Nov 2010), seven patients who underwent PD and presented at the time of operation, a main bile duct (MBD) greater of 20 mm, received a mechanical biliodigestive anastomosis with surgical stapler. All the patients were postoperatively controlled with an ultrasonography at 3 and 6 months, and a cholangio MRI at 1 year from operation. The follow up of the seven patients ranged from 3 to 18 months. Six patients are still alive and free of oncologic disease. One patient presented a single episode of cholangitis with a significant reduction of caliber of the biliodigestive anastomosis. The remaining five patients showed a good caliber of hepaticojejunal anastomosis. The authors suggest this procedure as a safe, feasible, more rapid and easier technique than traditional suture for bilioenteric anastomosis, when a suitable caliber of MBD allows to perform it.