P-224 - End to side dunking pancreatojejunostomy, thirty cases of Whipples procedure, our institutional experience

Abstract

Introduction: Pancreatic adenocarcinoma is the 9th most common cancer diagnosed worldwide however pancreatic cancer death ranks 4th in cancer death each year. Despite all possible treatment the 5 year survival remains dismal and less than 5% patients survive. Once resection of the specimen is done three anastomoses are established, pancreato-enteric, biliary-enteric and gastro-enteric anastomosis. Among these three anastomoses the pancreato-enteric anastomosis is the most crucial one and its complications are responsible for most of the morbidity and mortality of pancreatoduodenectomy surgery. Dunking method can be used in ‘end to end’ and ‘end to side’ ways. Regardless of the choice of technique the complication rate ranges from 30-50% and overall mortality rate between 1.4-10%. But there is paucity of data from Indian studies. Herewith we report our own experience with single layer end to side dunking pancreatojejunostomy technique in a retrospective study and evaluate postoperative complications in a tertiary care oncology centre in central India. Methods: From January 2013 to January 2016, 30 consecutive patients were studied retrospectively who underwent pancreatoduodenectomy for malignant pancreatic disease. 19 patients were diagnosed to have periampullary carcinoma and 11patients had carcinoma head of pancreas. All the patients underwent standard Whipple’s operation. After resection of the specimen pancreatojejunal anastomosis was established in end to side dunking fashion. Results: 17 patients were male and 13 were female. Mean age of the patients were 53.9 years (range 19 – 70 years). Jaundice and weight loss were most common symptoms in these patients. Mean operative time was 3.5 hours approximately. And mean blood loss was 250 ml (range 150 – 400ml). None of the patients showed postoperative anastomotic leakage or pancreatic fistula. Mean hospital stay was 15 days (range 13 – 20 days). There was no peri-operative mortality. Conclusion: Anastomotic technique remains the most important factor to reduce the risk of pancreatic leak hence time to time many surgeons worldwide improvise upon the surgical technique. Despite many techniques none of the techniques yet have been proven to be superior to the others conclusively. In the present study all the cases were malignant pancreatic disease and majority had soft and friable pancreas. In soft and friable pancreas dunking technique appears to be better as compared to duct to mucosa technique which is better for fibrotic pancreas and dilated main pancreatic duct