Postoperative Complications and Management of Pancreaticoduodenectomy

Toshihide Imaizumi

Department of Gastroenterological Surgery, Tokyo Women's Medical College

Since 1968, 964 patients have received pancreaticoduodenectomy (PD) in our department. Early complications occurred in 27% of the patients and the hospital death rate was 9%,. One-third of the early complications resulted from insufficiencies of the pancreaticojejunostomy, which were found in as high as 11% of the patients with a soft normal pancreas without fibrosis (p<0.001). These insufficiencies consisted of surgical pancreatic injury, stenosis of the pancreatic duct and a resultant intraperitoneal abscess and bleeding. Thorough draiange around the site of the pancreaticojejunostomy with careful monitoring of the surgical pancreatic injury is important in the management of the former two conditions, and the US/CT drainage or TAE is useful for the latter two conditions. As late complications, cholangitis (in 13% of the 964 patients), which results from stasis in the reconstructed jejunum due to the abolition of the duodenal papillary sphincter function after PD, and pancreatitis (3%) occurred in addition to the stenosis at the site of the choledocho/pancreaticojejunostomy. Diabetes mellitus (7%) and peptid ulcer (3%) were also observed. These complications were effectively managed by bougienage and/or reanastomosis and by jejunal adhesiotomy and/or alteration of the method of reconstructing the choledocho-/ pancreaticojejunostomy after PD. The US/CT-drainage was effective in the management of liver abscess.

Key words
early complications after pancreaticoduodenectomy, insufficiency of pancreaticojejunostomy after pancreaticojejunostomy, late complications after pancreaticoduodenectomy

Reprint requests
Toshihide Imaizumi Department of Gastroenterological Surgery, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
November 15, 1995

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