A Technique for Witzel Tunnel Catheter Drainage of the Biliary and Pancreatic Anastomosis of a Whipple Procedure

Abstract

Introduction: Stenting the pancreatic and biliary anastomoses in a Whipple procedure has been shown to lower the rate of anastomotic leak. Method: We have identified a combined biliary and pancreatic ductal external drainage catheter/stent to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the hepatico-jejunostomy. The silastic feeding tube is then advanced into the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. The combined tubes then exits the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. Results: Our technique offers several advantages. It’s a more durable way of stenting the two anastomoses and prevents stent migration. It provides an opportunity to study the two anastomosis via contrast administration. The witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several IR/endoscopic interventions. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter/stent system has many theoretical advantages.