Primary Closure and Serosal Patch of the Pancreatic Stump is an Alternative in Selected Patients Undergoing Pancreaticoduodenectomy

Objective Post-operative pancreatic fistula after pancreaticoduodenectomy is a common complication leading to increased morbidity and mortality. We present a modification to the technique of no pancreatic anastomosis, with primary closure of the pancreatic stump combined with a serosal patch. This technique should be considered in operations where a safe anastomosis cannot be achieved. Methods A retrospective analysis of patients’ files who underwent pancreaticoduodenectomy for periampullary benign or malignant lesions between 2002 and 2014 in one medical center. Results Fourteen (12.6%) of 111 patients who underwent pancreaticoduodenectomy were in need of primary closure and serosal patch. Postoperative pancreatic fistula was diagnosed in 3 (21.4%) patients. All postoperative fistulas were grade A. Pancreatic endocrine function was preserved in all patients. In 10 (71.4%) patients the pancreatic exocrine function was lost and pancreatic enzyme supplements were added to their diet. No acute or chronic pancreatitis developed during the follow up period. Conclusions Primary closure and serosal patch should be considered in cases where a safe anastomosis cannot be achieved. In the 14 patients described here, it proved to be safe and efficient in reducing the severity of postoperative pancreatic fistula.

Author(s): Ahmad Mahamid, Itamar Ashkenazi, Boris Kessel, Amit Hochberg, Ricardo Alfici

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