Management Of The Pancreatic Stump After Pancreaticoduodenectomv For cancer Pancreas

Abstract

Despite reductions Ill mortality after pancreaticoduodenectomy, leakage from the pancreatic remnant remains a major cause of morbidity and can contribute to mortality. Management of the pancreatic stump after pancreaticoduodenectomy is still a matter of debate. The most common techniques for management of the pancreatic remnant involve a pancreatic-enteric anastomosis, usually either pancreaticojejunostomy or pancreaticogastrostomy. Many variations of pancreaticojejunostomy have been described, including the site of jejunum used (end vs. side), the type of anastomosis (invagination vs. duct-to-mucosa), the use of isolated Roux-en-Y limbs, and the use of pancreatic ductal stenting or fibrin glue. A lack of agreement exists regarding the safest technique of pancreaticojejunostomy.

Pancreaticogastrostomy has gained favor in recent years as a potential means of reducing the incidence of pancreatic leakage after pancreaticoduodenectomy.