Article
Reconstruction after pancreatic head resection
Search Medline for
Authors
-
Gregor Cammerer
- Universitätsklinikum Ulm, Allgemein- und Viszeralchirurgie, Ulm
-
Rainer Isenmann
- St. Anna-Virngrund-Klinik, Abt. Allgemein-, Visceral- und Unfallchirurgie, Ellwangen
-
Christian Bialas
- Sanaklinikum Biberach Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Abteilung für Allgemein und Viszeralchirurgie, Biberach
-
Doris Henne-Bruns
- Universitätsklinikum Ulm, Allgemein- und Viszeralchirurgie, Ulm
| Published: | March 21, 2014 |
|---|
Outline
Text
Introduction: Pancreatic head resections are frequently performed for various indications just as pancreatic carcinomas, periamullary carcinomas or chronic pancreatitis. For reconstruction of gastrointestinal continuity two techniques, including their variations, are mainly perfomed: first the traditional technique using two jejunal loops and second the pylorus preserving resection with single loop reconstruction. Both techniques are considered to have several advantages as well as disadvantages.
Material and methods: During the last 10 years several patients which were operated at the Department of General and Visceral Surgery, University of Ulm, underwent a modiefied reconstruction after pancreatic head reconstruction. In these patients an antrum preserving single loop reconstruction was performed. The data of the patients were now analyzed retrospectively regarding the overall and especially functional results and mortility disorders.
Results: 226 patients with pancreatic head resection and reconstruction either by the pylorus preserving technique (n=176) or the antrum preserving technique (n=50) were analyzed. For parameters like median operation time, median blood loss, in hospital stay or postoperative complications no significant difference could be observed between the two reconstruction techniques. Requiring reoperation was only observed in the pylorus preserving group. A delayed gastric emtying proven by radiological findings was observed four times in the pylorus preserving group.
Conclusion: The pylorus preserving and the antrum preserving technique are operative procedures with comparable perioperative mortality and morbidity without any difference and economic aspects as operation time, blood loss and in hospitaly stay. Also an equal overal survial rate was observed in patients with pancreatic carcinoma. A delayed gastric emtying or stenosis at the gastro jejunal anastomosis could be avoided in the antrum preserving group. We therefore recommend this technique in patients with advanced tumor stages in order to avoid the prolonged in hospital stay.
