Outcome of Pancreatic Anastomosis after Whipple's Operation

Pancreaticoduodenectomy PD (Whipple procedure) remains the procedure of choice for tumors of the periampullary region. However, complications related to the pancreatic remnant, such as pancreatic fistula, anastomotic dehiscence, abscess formation, and septic hemorrhage are the main causes of morbidity and mortality. Some authors have named the pancreatic anastomosis the "Achilles heel" of pancreatic surgery because it has the highest rate of surgical complications. Management of the pancreatic remnant after partial pancreaticoduodenectomy is still controversial. The aim of this prospective study was to compare between three different but commonly performed anastomosis namely; end to end pancreaticojejunostomy, end to side pancreaticojejunostomy, and pancreaticogastrostomy after Whipple operation. Thirty patients were the subjects of the present study and were randomly divided into three equal groups: End to end pancreaticojejunostomy (group I), end to side pancreaticojejunostomy (group II) and end to side pancreaticogastrostomy (group III). Our study proved that there was no significant difference as regards leakage after different types of pancreatic anastomosis after Whipple operation. However it was shown that there was a direct link between pancreatic duct size, pancreatic texture and the incidence of pancreatic fistula.