A New Technique For Prevention of Postoperative Complications After Gastropancreaticoduodenal Resections

Abstract

Pancreaticoduodenal resection- is the only radical method of treating the tumour of the biliopancreaticoduodenal zones and chronic pseudotumour lesions of the head of the pancreas. The aim of our work is to increase good results of the gastropancreaticoduodenal resections. From 1984-2006 in the Syzganov A.N. National scientific center of surgery, 138 pancreaticoduodenal resections were carried out due to tumors of the pancreaticoduodenal zones and chronic bulbous pseudotumourous pancrearitis. For finding out the specific complication of the gastropancreaticoduodenal resection, 103 patient’s medical records of the control group were analyzed. Based on our experiences, we have the following indications before carrying out our methods of pancreatodigestive anastomosis.Our method of the gastropancreaticoduodenal resection has reduced the post-surgical complications: acute pancreatitis of the pancreatic stump –from 49 incidence (47,5%) to only one (2,8%), pancreonecrosis -16 (15,5%) to 0, indehiscence of the pancreaticojejunal anastomosis –from 25 (24,2%) to 2 (5,7%), indehiscence of the hepaticojejunal anastomosis – from 14 (13,6%) to 1 (2,8%), indehiscence of the gastrointestinal anastomosis – from 2 (1,9%) to 0. Gastrointestinal bleeding –from 6 (5,8%) to 1 (2,8%), intestinal fistulas – from 2 (1,9%) to 0, pancreatic fistulas – from 4 (3,9%) to 0, gastro stasis from 10 (9,7%) to 0. In the control group, the most common reason of the mortality was peritonitis in (49,9%) due to indehiscence and necrosis of the pancreas and development of retroperitoneal phlegmons and abscess, and also erosive bleeding (43,8%). In the main group within the last three years among the 35 operated patients with our methods, there was a mortality in one case (2,8%). After all, we can conclude that, the newly developed method of invaginating pancreaticojejunal anastomosis “end to end” with adequate drainage of the anastomosis zone through microjejunostomy provides decompression of the zone of the pancreaticojejunal anastomosis through microjejunostomy, hence reduced the indehiscence of the pancreaticojejunal anastomosis.