J.Jpn. Surg. Soc.. 120(4): 425-430, 2019

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Feature topic

TWO-STAGE PANCREATOJEJUNOTOMY IN PANCREATODUODENECTOMY

The morbidity rate associated with pancreatic fistula following pancreatoduodenectomy (PD) remains high. To decrease the rate of severe complications after PD, we have applied a two-stage pancreatojejunostomy for patients with soft pancreas and inflammation around the pancreas, as well as those undergoing hepatopancreatoduodenectomy (HPD). In the first stage of the procedure, a tube stent is inserted and fixed to the main pancreatic duct for total drainage of the pancreatic juice without anastomosis. About 3 months after the first operation, a two-stage operation is planned. The fistula made around the tube stent is dissected, and after exposing the stump of the pancreas, a pancreatojejunostomy (duct-to-mucosa anastomosis) is made preserving the adhesion around the pancreas. The potential concerns include: 1) the second operation is somewhat technically demanding; and 2) some patients with early tumor recurrence cannot undergo the second procedure. Nevertheless, this two-stage strategy has been reported to contribute to improvement of the safety of PD and HPD. An appropriate combination of postoperative chemotherapy and this two-stage strategy may provide favorable short- and long-term outcomes.

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