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Roh, Kim, Jung, and Kim: Comparing the Results of Method of Jejunal Anastmosis at Pylous-preserving Pancreaticoduodenectomy
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(2): 120-126.

Published online: 4 August 2009

DOI: https://doi.org/10.4174/jkss.2009.77.2.120

Comparing the Results of Method of Jejunal Anastmosis at Pylous-preserving Pancreaticoduodenectomy

Young Hoon Roh, M.D., Ki Hwan Kim, M.D., Ghap Joong Jung, M.D., Young Hoon Kim, M.D.

Department of Surgery, Dong-A University College of Medicine, Busan, Korea.

Corresponding author (yhkim1@dau.ac.kr)

Received 25 April 2009       Accepted 15 June 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

After performing pylous-preserving pancreaticoduodenectomy, there are several methods of performing pancreaticojejunostomy for preventing pancreatic leakage. The purpose of this study was to compare the results of two methods of jejunal anastomosis after pancreaticojejunostomy.

Methods

We retrospectively evaluated the clinical results of 49 patients who had received pancreaticojejunostomy for pylous-preserving pancreaticoduodenectomy. One method is the Billroth-I type, that is, choledochojejunostomy and pancreaticojejunostomy after anastomosis of one jejunum loop to the duodenum. The other method is the Roux-En-Y (R-Y) type. Choledochojejunostomy and pancreaticojejunostomy are done with an isolated jejunum loop. Then gastrojejunostomy is fashioned between the stomach and the distal jejunal segment. Finally, the end-to-side jejunojejunostomy is created.

Results

The Billroth-I type was used in 17 patients and the R-Y type was used in 32 patients. The median operation time was 397 min and 431 min, respectively. The median postoperative hospital day was 27.6 days and 22.1 days, respectively. The postoperative complications were 10 cases in 17 patients (58.8%) and 11 cases in 32 patients (34.4%), respectively. Leakage of the pancreaticojejunostomy was the most common complication in each group (23.5% and 15.6%, respectively). Most complications required no need surgical intervention. But two cases of Billroth-I type complications needed total pancreatectomy because of leakage of the pancreaticojejunostomy.

Conclusion

Not only were there fewer complications for the R-Y type than for the Billroth-I type, but there was no need for operation to treat the complications of the R-Y type because of the isolated jejunal loop.

Keywords: Pylous-preserving pancreaticoduodenectomy, Pancreaticojejunostomy leakage

Figures and Tables

Fig. 1
Schematic view of Billroth-I anastomosis method.
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Fig. 2
Schematic view of Roux-En-Y anastomosis method.
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Table 1
Clinicopathologic characters
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*Group I = Billroth-I type pancreaticojejunostomy; †Group II = Roux-En-Y type pancreaticojejunostomy; ‡IPMT = intraductal papillaray mucinous tumor.

Table 2
Operative outcomes
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Table 3
Postoperative complications
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No. of patients: Group I = 10/17 (58.8%); Group II = 11/32 (34.4%) (P=0.422).

Table 4
Treatment of complications
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*PNAD = percutaneous needle aspiration & drainage.

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