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Role of External Pancreatic Drainage in Pancreaticogastrostomy in Whipples Procedure

M. Muralidhar, Assistant Professor, Department of Surgical Oncology, MNJ Institute of Oncology and Regional Cancer Center, Osmania Medical College, Hyderabad, Telangana 500095, India. , M. Muralidhar* , M. Srinivasulu**

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Indian Journal of Cancer Education and Research 6(1):p 65-72, January-June 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6118.8

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Abstract

 

Introduction: Since the introduction of pancreaticoduodenectomy the major morbidity and cause of mortalityhas been pancreatic leak from  the pancreatic anastomosis(pancreatojejunostomy or pancreatogastrostomy).

Materials and Methods: This is a prospective non­randomized study, aimed at short term analysis of outcome of pancreaticogastrostomy with external stenting in Whipple’s procedure conducted inthose patients found to be suffering from periampullary carcinoma. 

Results: A prospective series of 12 patients, with pancreatic and preambulary cancers outlined Whipple’s procedure as required. Pancreatic anastomosis was done by pancreaticogastrostomy with external stenting. Whipples procedure in our hands had a mortality of 8.3% and a morbidity of 40­ 50%. The procedure is technically feasible with an operating time of four hours and a blood loss of 1000ml. Preoperative biliary stenting did not influence the leak rate. The one mortality in our study was not related to the pancreatic leak. The one patient with pancreatic leak and had only a minimal leak (Grade A) which was easily managed conservatively. All the other complications were managed conservatively with success in all patients. 

Conclusion: Pancreaticogastrostomy with external stenting is a safe and reliable procedure which can be routinely performed in Whipples procedure.

Keywords: Pancreaticogastrostomy; Whipples Procedure; Anastomosis; Adenocarcinoma.

 

 

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DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6118.8

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