Background and Objectives: Pancreaticoduodenectomy is still associated with
high morbidity and mortality even though there has been significant progre
ss in the field of pancreatic surgery and postoperative follow-up. The panc
reatoenteric anastomosis, regardless of the technique used, is a major caus
e for both morbidity and mortality after Whipple procedure. To overcome all
problems resulting from anastomotic leakage, we used external drainage of
the pancreatic duct.
Methods: In 24 patients who underwent pancreaticoduodenectomy in our Depart
ment from 1986 to 1995, a modification to the standard Whipple procedure wa
s performed. Instead of pancreaticoenteric anastomosis, external drainage o
f the pancreatic duct remnant was performed. The pancreatic duct was intuba
ted with a silastic tube, the external end of which was sutured to the skin
. All patients received substitution therapy with pancreatic enzymes.
Results: Mortality in our group of patients was 4%. No complications due to
the external drainage of the pancreatic duct were reported, while no patie
nt developed diabetes mellitus after surgery.
Conclusions: External drainage of the pancreatic duct renmant can be used a
lternatively to pancreatoenteric anastomosis after pancreatoduodenectomy. T
he technique is safe and simple to perform and appears to reduce overall op
erative time. It may be an option for patients with significant comorbidity
and/or intraoperative hemodynamic instability which mandates expeditious c
ompletion of the operation. (C) 2001 Wiley-Liss, Inc.