This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Late morbidity after duodenum‐preserving pancreatic head resection with bile duct reinsertion into the resection cavity. BJS 2008; 95: 447-452.
Published: 27th December 2007
Authors: G. Cataldegirmen, D. Bogoevski, O. Mann, J. T. Kaifi, J. R. Izbicki, E. F. Yekebas et al.
Background
Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum‐preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.
Method
Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus‐preserving pancreatoduodenectomy (PPPD).
Results
There were no deaths after DPPHE with CBD reinsertion, compared with four (0·9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28·9 and 36 per cent respectively. Fifteen patients (18 per cent) who had DPPHE with CBD reinsertion developed a stricture at the reinsertion site, compared with a long‐term stricture rate of 2·3 per cent (ten patients) after DPPHE without CBD reinsertion and 4 per cent (two patients) after PPPD/Whipple resection.
Conclusion
Although associated with a high incidence of anastomotic stricture, reinsertion of the CBD into the resection cavity as part of DPPHE can be used to preserve duodenal passage and offers an alternative to extended resection for chronic pancreatitis. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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