[Technical possibilities for preventing insufficiency of pancreaticojejunostomy anastomosis]

Today, insufficiency of pancreatic anastomosis is a rare complication following pancreatic head resection. Thirty years ago, insufficiency rates and mortality after Kausch-Whipples operations were from 30% to 52%. What makes pancreatic anastomosis certain today? 1. An end-to-side technique in telescopic manner should be preferred. 2. Pancreogastric anastomosis is also possible. 3. Fibrin occlusion of the pancreatic duct system would be helpful. 4. Simultaneous decrease in pancreatic secretion by octreotide seems to be a well-proven help in avoiding pancreatic anastomosis failure.