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KMID : 1143920210250030371
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Annals of Hepato-Biliary-Pancreatic Surgery
2021 Volume.25 No. 3 p.371 ~ p.375
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Anterior pancreatic duct split prior to duct-to-mucosa pancreatico-jejunal anastomosis in pancreaticoduodenectomy
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Gadiyaram Srikanth
Nachiappan Murugappan
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Abstract
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A secure pancreatic-enteric anastomosis is widely accepted as the ‘Achilles heel’ in reconstruction following a pancreaticoduodenectomy. Most morbidity following the procedure is related to the failure of this anastomosis, resulting in intra-abdominal collections, secondary haemorrhage, delayed gastric emptying, need for radiological interventions and re-operation for some patients. Of several techniques available, the ‘duct-to-mucosa’ technique is widely employed for pancreaticojejunal anastomosis. Among several refinements to facilitate this anastomosis, viz; mobilization of pancreatic stump, magnification with loupes and modifications made on the jejunal side to enable a tension free anastomosis, none seems to address the pancreatic duct in particular. The operative technique of anterior pancreatic duct split described by us enables a wider, well visualized pancreatic duct for a secure duct to mucosa pancreaticojejunal anastomosis.
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KEYWORD
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Pancreas, Pancreaticoduodenectomy, Pancreaticojejunostomy, Duct-to-mucosa anastomosis, Anterior pancreatic duct split
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