Resection of pancreas without production of fistula

A method of management of the pancreatic stump after partial pancreatic resection is described which successfully prevented the development of postoperative pancreatic fistulas in 25 patients. After pancreaticoduodenectomy, performed upon ten of the patients, the pancreatic remnant was managed by ligation of the pancreatic duct, using an absorbable polyglycolic acid suture plus anastomotic invagination of the entire pancreatic stump into the jejunum. After distal subtotal pancreatectomy, performed upon 15 of the patients management of the pancreatic stump consisted of ductal ligation and provision of gentle occlusive coverage of the cut surface, using mattress sutures and an omental plug. Successful prevention of pancreatic fistulas in these patients probably depended upon ligation of the pancreatic ducts which precluded release of pancreatic enzymes into the jejunum and the juxtapancreatic region in the early postoperative period of healing.