Abstract
Complications after pancreato jejunostomy were investigated according to the type of anastomosis, and the usefulness of continuous intraabdominal suction drainage (CISD) was evaluated. One hundred and forty three patients were included in this study. The invagination method (type I) was used in 20 patients, the duct-insertion method with seromyotomy (type II) in 22, the duct-insertion method without seromyotomy (type III) in 48, and pancreaticojujunostomy followed by total layer anastomosis (type IV) in 53. The incidence of pancreatic fistula was 20% in the type I group, 21% in type II, 0% in type III, and 13% in type IV. The incidence of anastomotic leakage was 25%, 14%, 6%, and 4%, respectively. There was a significant difference in the frequency of anastomotic leakage between pancreatic cancer and biliary tract cancer (5% in pancreatic cancer versus 14% biliary cancer). Postoperative early death occurred in 25% of the patients in the type I group, 14% in type II, 12% in type III, 6% in type IV. There was a tendency toward a correlation between postoperative early death and anastomotic complications in the non-CISD group (p=0.06). However, there was no correlation between the two factors in CISD group. These results indicate that pancreaticojunostomy followed by total layer anastomosis and CISD are useful and safe procedures after pancreaticoduodenectomy.
