Invaginated Pancreaticojejunostomy via the Space Behind the Root of Superior Mesenteric Vessels

BACKGROUND: This study was to explore a safe and effective procedure to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD). METHODS: Forty-three modified PD with pancreaticojejunostomy by direct invagination of the pancreas to the jejunum that was brought up via the space behind the root of superior mesenteric vessel were performed between January 2003 and June 2006, and were compared to the fifty-six conventional PD (Child’ method). RESULTS: There was no pancreatic fistula after PD in the modified group. Two cases developed biliary fistula that were successfully treated with complete drainage for 2 to 3 weeks; 2 cases abdominal infection managed with anti-infection and completely drainage; 4 cases stress ulcer cured with Losec and coagulant. Three cases in the Child group developed PF of different severities, with amylase level > 9000 U/L in the abdominal drainage fluid. Two of the PF were treated with Stilamin, parenteral nutrition, fasting and completely drainage and cured after 21 to 32 days. The other 82-year-old patient died. Other complications had no significant difference between the two groups (P > 0.05). CONCLUSIONS: The modified PD can effectively prevent PF and is a safe and effective procedure for periampullary neoplasm. Further studies of its clinical use are warranted.