An easier technique for end to end pancreaticojejunostomy

Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains the most common and troublesome complication. Various procedures, such as duct ligation or occlusion, resection of the pancreatic stump or pancreaticogastrostomy, have been proposed to treat the pancreatic stump when it is considered unsuitable for jejunal anastomosis. A little trick permitted us to perform 41 consecutive end to end pancreaticojejunostomies, irrespective of the conditions of the pancreatic stump, with only 3 pancreatic fistulas (7%) and without fistula related deaths.