Pylorus Preserving Supracolic Dissected Pancreaticoduodenectomy with Binding Pancreaticojejunostomy

AUTHOR(s) : Ganguly N. Narendra, Bhattacharjee Nilotpal
DOI No. :

ABSTRACT :
Patients suffering from periampullary cancers undergo pancreaticoduodenectomy. A standard R0 resection is advisable for a fair survival. Complications after this procedure hover between 2% to 7% in different institutes and high output centers. The Achilles’ heel of this procedure is the pancreaticoenteric anastomosis. From simple pancreaticojejunal anastomosis to duct to mucosa, dunking, pancreaticogastrostomy with or without antral opening to binding pancreaticojejunostomy are followed in different institutes. The supracolic dissection makes the approach to the pancreatic mesentery easy. However pylorus preserving procedure makes gastrostomy difficult. In such a situation we present our small experience on the subject and the results herewith. From 2003 to 2011 we have taken up patients for Whipple’s surgery in our unit. We could operate on the six patients who were a part of almost 50 patients who were ultimately found to be operable. Few patients underwent Triple bypass and at least one patient we closed without any procedures because of the advanced nature of the disease. There was no operative mortality. One death on the 12th post op day due to ARDS(?) in the ICU. One died after 30 days. But all the patients were well after surgery. At least one patient survived over 24 months. The procedure mentioned here is worth a try. Keywords: Periampullary cancers, Whipple’s, Pancreaticoenterostomy, pancreaticoduodenectomy, R0 resection, pylorus preservation, supracolic dissection

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