[Results of defunctionalized jejunal loop after pancreaticoduodenectomy]. / Resultados de la derivación con 2 asas tras duodenopancreatectomía cefálica.

INTRODUCTION: Anastomotic leak continues to be a common cause of complications after pancreaticoduodenectomy. Numerous surgical techniques have been described to avoid this complication. OBJECTIVE: We evaluated the use of a defunctionalized jejunal loop for the pancreas after pancreaticoduodenectomy. MATERIAL AND METHODS: Between 1991 and 2005, the findings in 80 patients were analyzed in this prospective study of the use of a defunctionalized jejunal loop for the pancreas as a reconstructive procedure following pancreaticoduodenectomy. All the patients were operated on by two surgeons. The following clinical variables were recorded: age, sex, diameter of the main pancreatic duct, pancreas texture, operating time, intraoperative blood transfusion, mean length of hospital stay, and operative mortality. Seven complications were defined: anastomotic leakage (biliary and duodenal), pancreatic fistula, abscess, sepsis, bleeding, delayed gastric emptying, and postoperative pancreatitis. Four different definitions were used for pancreatic fistula. RESULTS: Of the 80 patients, 16 (20%) developed pancreatic fistula according to at least one of the criteria used. Pancreatic fistula was more frequent in patients with a small duct (33.3%), and soft pancreatic texture (29%), and was the cause of 100% of intraabdominal hemorrhages, 80% of abdominal abscesses, and 60% of mortality. The mean length of hospital stay was 20.6 days and the mortality rate was 6.6% (5/80). During follow-up two patients developed pancreatitis. CONCLUSION: After pancreaticoduodenectomy, reconstruction with a defunctionalized jejunal loop for the pancreas is a safe and effective technique.

Resultados de la derivación con 2 asas tras duodenopancreatectomía cefálica / Results of defunctionalized jejunal loop after Pancreaticoduodenectomy

Introducción. La fístula pancreática continúa siendo una causa frecuente de complicaciones tras la realización de una duodenopancreatectomía cefálica. Se han descrito múltiples técnicas quirúrgicas para evitar esta complicación. Objetivo. Los autores evalúan la utilización de un asa desfuncionalizada para la anastomosis pancreática tras duodenopancreatectomía cefálica. Material y métodos. Entre el año 1991 y 2005 se han analizado de forma prospectiva los resultados de 80 pacientes en los que se utilizó un asa desfuncionalizada para la anastomosis pancreática como método de reconstrucción después de una duodenopancreatectomía cefálica. Todos los pacientes fueron intervenidos por 2 cirujanos. Se recogieron las siguientes variables clínicas: edad, sexo, diámetro del conducto pancreático, textura del páncreas, duración de la intervención, transfusión intraoperatoria, estancia hospitalaria y mortalidad operatoria. Se definieron 7 complicaciones de la técnica: fístula anastomótica (biliar o duodenal), fístula pancreática definida de 4 formas diferentes, absceso abdominal, sepsis, hemorragia, retraso en el vaciamiento gástrico y pancreatitis postoperatoria. Resultados. Dieciséis pacientes (20%) de los 80 que formaron parte del estudio presentaron fístula pancreática por alguno de los criterios utilizados. La fístula pancreática fue más frecuente en pacientes con conducto pequeño (33,3%), páncreas blando (29%) y fue la causa del 100% de la hemorragia, el 80% de los abscesos abdominales y el 60% de la mortalidad. La estancia media hospitalaria fue de 20,6 días y la mortalidad del 6,6% (5/80). En el seguimiento, 2 pacientes han presentado pancreatitis de repetición (AU)

Introduction. Anastomotic leak continues to be a common cause of complications after pancreaticoduodenectomy. Numerous surgical techniques have been described to avoid this complication. Objective. We evaluated the use of a defunctionalized jejunal loop for the pancreas after pancreaticoduodenectomy. Material and methods. Between 1991 and 2005, the findings in 80 patients were analyzed in this prospective study of the use of a defunctionalized jejunal loop for the pancreas as a reconstructive procedure following pancreaticoduodenectomy. All the patients were operated on by two surgeons. The following clinical variables were recorded: age, sex, diameter of the main pancreatic duct, pancreas texture, operating time, intraoperative blood transfusion, mean length of hospital stay, and operative mortality. Seven complications were defined: anastomotic leakage (biliary and duodenal), pancreatic fistula, abscess, sepsis, bleeding, delayed gastric emptying, and postoperative pancreatitis. Four different definitions were used for pancreatic fistula. Results. Of the 80 patients, 16 (20%) developed pancreatic fistula according to at least one of the criteria used. Pancreatic fistula was more frequent in patients with a small duct (33.3%), and soft pancreatic texture (29%), and was the cause of 100% of intraabdominal hemorrhages, 80% of abdominal abscesses, and 60% of mortality. The mean length of hospital stay was 20.6 days and the mortality rate was 6.6% (5/80). During follow-up two patients developed pancreatitis. Conclusion. After pancreaticoduodenectomy, reconstruction with a defunctionalized jejunal loop for the pancreas is a safe and effective technique (AU)