A technique for witzel tunnel catheter drainage of the biliary and pancreatic anastomosis of a Whipple procedure

Presenter: Mridul Pansari MD | Florida Atlantic University Background: Stenting of the pancreatic and biliary anastomoses a Whipple procedure has been shown to lower rate anastomotic leak in several retrospective prospective studies. We describe here combined ductal external drainage catheter we have used successfully our pancreatico-duodenectomy operations. Methods: identified / stent which construct on operating table decompress small bowel limb both anastomoses. The single is combination red Robinson silastic pediatric feeding tube each appropriate size for duct they are draining. inserted into lumen rubber though tight fenestration elastic segment exits through similar at level choledocho or hepatico- jejunostomy. then advanced well where it secured mucosa with fine absorbable suture prevent dislodgement. Multiple extra openings cut tubes their distal segments facilitate drainage. exeunt “Whipple limb” Witzel tunnel. right upper quadrant abdominal wall interrupted 3-0 Vicryl sutures. skin externally heavy nylon suture. outer part benzoin three ¼ inch steri-strips. Both catheters connected separate bags. perform pancraetico- jejunostomy layer silk bile anastomosis 4-0 5-0 PDS Maxon Two 10 mm Jackson Pratt drains placed quadrant. Results: There theoretical advantages that offers. First, diverts fluid bile, decreasing it's flow respective helps healing anastomosis. Secondly, technique more durable way stenting two migration stents. areas resistance prevents its migration. portion, internal portion mucosal stitch hold place. kept place by tunnel itself. Third advantage provides an opportunity study via contrast administration. Fourth, witzel anchoring jejunal lateral opens door wire based treatments Seldinger fashion, should be post operative period. Conclusion: use system many advantages.