Outcome of Pancreatic Anastomosis after Whipple’s Operation, a Cohort Study

Abstract

Pancreaticoduedenectomy is the operative of choice in cases of resectable tumors of the periampullary region. Critical step in pancreatic surgery is no longer the resection itself but the reconstruction of the pancreaticoenteric anastomosis. Different methods of pancreatic reconstruction have been proposed aiming to limit the rate of leakage of pancreatic anastomosis. Surgeons have attempted to lower leak rates by devising a number of anastomotic techniques such as end to end pacreaticojejunostomy versus (vs) end to side pacreatico-jejunostomy, duct to mucosa anastomosis vs dunking anastomosis, pacreaticojejunostomy versus pacreatico-gastostomy and the use of internal or external stent. Many studies were constructed to compare the incidence of leakage among different methods of pancreatic anastomosis. The main aim was to define the ideal type of pancreatic anastomosis so as to decrease morbidity and mortality. Our study proved that there is no significant difference as regard leakage after different types of pancreatic anastomosis. However it was accidentally proved that there is a direct link between pancreatic duct size, pancreatic texture and the incidence of pancreatic fistula. In other words, soft pancreatic texture and narrow duct have higher incidence of pancreatic fistula.