[Pancreatic anastomosis after pancreatoduodenectomy]

Leakage from a pancreatic anastomosis after a pancreatoduodenectomy is one of the serious problems that can bring on life-threatening complications and lead to operative mortality. To minimize these complications, various reconstruction methods have been proposed. A series of 183 patients underwent pancreatoduodenectomy between August 1981 and December 1996 at 1st Department of Surgery, Teikyo University School of Medicine. Our pancreatic anastomoses were classified into four groups based on "Classification of Pancreatic Carcinoma (Japan Pancreas Society, FirstEnglish Edition, Kanehara, Tokyo 1996)",: (a) mucosa-to-mucosa pancreatico jejunostomy in 58 cases, (b) tube assisted (telescoped typed) pancreaticojejunostomyin 104, (c) pancreaticojejunostomy through dunking method in 2, and (d) panc reaticogastrostomy in 19. The leakage occured in 5 out of 104 of tube-assisted pancreaticojejunostomy, in 1 out of 19 of pancreaticogastrostomy. Due to the smooth healing process of anastomosis, mucosa-to-mucosa pancreaticojejunostomy have been applied, leading to results were no leakage occurred in 58 consecutive cases.