Comparing the Results of Method of Jejunal Anastmosis at Pylous-preserving Pancreaticoduodenectomy

Purpose: After performing pylous-preserving pancreaticoduodenectomy, there are several methods of performing pancreaticojejunostomy for preventing pancreatic leakage. The purpose of this study was to compare the results of two methods of jejunal anastomosis after pancreaticojejunostomy. Methods: We retrospectively evaluated the clinical results of 49 patients who had received pancreaticojejunostomy for pylous-preserving pancreaticoduodenectomy. One method is the Billroth-I type, that is, choledochojejunostomy and pancreaticojejunostomy after anastomosis of one jejunum loop to the duodenum. The other method is the Roux-En-Y (R-Y) type. Choledochojejunostomy and pancreaticojejunostomy are done with an isolated jejunum loop. Then gastrojejunostomy is fashioned between the stomach and the distal jejunal segment. Finally, the end-to-side jejunojejunostomy is created. Results: The Billroth-I type was used in 17 patients and the R-Y type was used in 32 patients. The median operation time was 397 min and 431 min, respectively. The median postoperative hospital day was 27.6 days and 22.1 days, respectively. The postoperative complications were 10 cases in 17 patients (58.8%) and 11 cases in 32 patients (34.4%), respectively. Leakage of the pancreaticojejunostomy was the most common complication in each group (23.5% and 15.6%, respectively). Most complications required no need surgical intervention. But two cases of Billroth-I type complications needed total pancreatectomy because of leakage of the pancreaticojejunostomy. Conclusion: Not only were there fewer complications for the R-Y type than for the Billroth-I type, but there was no need for operation to treat the complications of the R-Y type because of the isolated jejunal loop. (J Korean Surg Soc 2009;77:120-126)