A study on the efficacy of single layer full thickness duct to mucosa pancreatojejunostomy following pancreatoduodenectomy.

Abstract

Objective: Pancreatoduodenectomy is the procedure of choice for treating periampullary and pancreatic head malignancy. The procedure has been standardized and the mortality has reduced considerably to fewer than 5% in high volume centers specializing in pancreatic surgeries. Unfortunately, the morbidity still hovers around 40%. The Achiles heal of pancreatoduodenectomy is the pancreatoenteric anastamosis, the failure of which leads to significant morbidity. Literature is flooded with a plethora of techniques of reconstruction, and the results are variable. In this present study, we have analyzed a technique in which we used a single layer full thickness duct to mucosa pancreatojejunostomy. Among the 25 subjects in this study, there was only one case of one mortality due to drug-induced cardiac arrhythmia, and no mortality secondary to pancreas-specific complications were reported. The present study was a pilot study compared with historical controls, where these results were comparable to the historical data reported earlier as well as our own historical data of two-layered anastamosis. The results of this pilot study supported our concept of single layer full thickness duct to mucosa anastamosis being least traumatic to the pancreas and having an equal efficacy to that other conventional techniques.