Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method

Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure. 1. Introduction Progress in surgical technique and perioperative management has significantly reduced the morbidity and mortality rate of pancreatic resection procedures [1, 2]. The majority of postoperative complications after pancreatoduodenectomy (PD) arise from pancreatic leakage by the pancreatic stump. The pancreatic anastomosis is called by some authors the “Achilles heel” of pancreatic surgery due to its high rate of complications among all abdominal anastomoses [3, 4]. The optimal management of the pancreatic remnant after PD remains a challenge. More than 80 different methods of pancreaticoenteric reconstruction have been described, indicating the absence of a gold standard technique [5]. An interesting alternative option is the pancreatic stump occlusion technique with various methods. Our institution’s eight-year experience using this approach in a nonselected group of patients is presented herein. The objective of our trial was to compare the two operative approaches for the management of the pancreatic remnant with regard to mean operative time, postoperative complications, oncological parameters, and one-year survival rates. 2. Materials