Two-Stage Pancreaticoduodenectomy to Prevent Postoperative Hemorrhagic Complications in Jehovah's Witness Patients

Abstract

Pancreaticoduodenectomy (PD) in Jehovah's Witness patients who refuse blood transfusion on religious grounds has rarely been reported. PD is associated with substantial intraoperative blood loss and a high risk of postoperative complications, particularly pancreatic fistula, which may lead to life-threatening hemorrhage due to aneurysmal rupture. Therefore, preoperative consent for blood transfusion is generally considered necessary prior to PD. We performed PD in Jehovah's Witness patients with periampullary malignancies using the following strategies. First, a planned two-stage surgical approach was adopted. Second, to prevent massive hemorrhage from major vessels due to suture failure, the greater omentum was used to cover and secure both the pancreatic stump and the divided stump of the gastroduodenal artery during the initial operation. Third, pancreatic duct fistulojejunostomy, a novel technique considered safer and technically simpler than conventional pancreatojejunostomy, was performed. We report the outcomes of eight Jehovah's Witness patients who underwent transfusion-free PD using these strategies. Most patients had an uneventful early postoperative course, and long-term survival outcomes were also favorable. This paper describes the technical innovations and surgical experience of PD in Jehovah's Witness patients refusing blood transfusion.