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Pancreaticoduodenectomy with Roux-Y anastomosis in reconstructing the digestive tract: report of 26 patients |
You-Gang Ma, Xiao-Song Li, Han Chen, Meng-Cao Wu |
From the Department of Second Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China (Ma YG, Li XS, Chen H and Wu MC)
Correspondence: You-Gang Ma, MD (Tel: 86-21-25070789; Fax: 86-21-65510688; Email: 25588@163.com) |
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Abstract Objective: To explore the way to lower the morbidity and mortality of patients after pancreaticoduodenectomy.
Methods: Between March 1998 and March 2001, 26 patients with periampullary tumors received pancreaticoduodenectomy (PD) with Roux-Y anastomosis to reconstruct the digestive tract. Of these patients, 6 had ductal cell carcinoma at the head of the pancreas, 8 distal common bile duct carcinoma, 5 ampullar adenocarcinoma of the Vater, 6 duodenal adenocarcinoma, and 1 duodenal malignant lynphoma. A 30-40 cm free vascularized segment of the proximal jejunum was taken and pulled up to the bed of the duodenum for end-to-end pancreaticojejunostomy, end-to-side choledocojejunostomy or side-to-side jejunojejunostomy by a single loop.
Results: The operative mortality was zero. Postoperative intraabdominal hemorrhage occurred in 2 patients, but no leakage during pancreaticojejunostomy or choledocojejunostomy as well as abdominal infection. The patients were discharged from the hospital on the tenth to fourteenth day after operation. Follow-up for 5 to 36 months (mean 21 months) revealed chronic steatorrhea and malnutrition in one patient (3.85%), and good digestive function and normal nutritional status in 25 (96.15%). No bile reflux gastritis, retrograde infection, anastomotic ulcer, and dumping syndrome were observed.
Conclusion: Our results show that this procedure can effectively reduce the morbidity and mortality of patients after PD.
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