Efficiency of Roux-En-Y Reconstruction After Pancreaticoduodenectomy

Abstract

Background: Pancreatic anastomotic failure remains among the most common and potentially lethal postoperative complications of pancreaticoduodenectomy. Use of a Roux-en-Y loop for reconstruction of pancreatic drainage is a technique that has been suggested to reduce pancreatic anastomotic leak-related morbidity and mortality in patients undergoing pancreaticoduodenectomy. Methods: A randomizing trial was started in 2009 and now involving 27 patients who underwent pancreatic head resections. Reconstruction of the pancreatic remnant was done using a single loop (SL) in 12 patients and by an original technique - totally isolated Roux-en-Y loop's (TIR) in 15 patients. Our reconstructive method aims at a complete separation of passage of gastric contents, bile and pancreatic juice. Thus we prevent any types of possible refluxes and related complications (pancreatic leakage, cholangitis, gastric ulceration). All pancreatic anastomosis were performed as a duct to mucosa anastomosis, in two layers, without pancreatic stent. Pancreatic fistula was defined as drainage of greater than 50ml of amylase rich fluid on or after postoperative day 5. Results: TIR was associated with a reduction of the incidence of pancreatic anastomotic leak (SL, 36%; TIR, 16.6%), reduction of the required postoperative interventional radiology procedures (SL, 27%; TIR, 8.3%). There are no incidents of postoperative cholangitis in TIR group (SL, 27%). Developed technique was accompanied by slight prolongation of the operative time (SL, 4.3 ± 0.4h; TIR, 5.5 ± 0.4h; p < 0.001). Conclusion: Use of the alternative Roux-en-Y technique for reconstruction following the Whipple procedure may decrease the incidence of pancreatic fistula and delayed gastric emptying. In addition, it has the added benefit of eliminating postoperative cholangitis. (Figure presented) .