Clinical Evaluation of Modified Reconstruction Method after Pancreatoduodenectomy

Background/Aims: The new reconstruction procedure after pancreatoduodenectomy (PD) is described to evaluate its usefulness. Methodology: The jejunum was made for an end-to-side choledochojejunostomy, and the cut proximal jejunum for approximately 20cm was led to the pancreatic stump for end-to-end anastomosis with telescoping. Approximately 20cm of jejunum was created with a side-to-end anastomosis with the stomach, and end-to-side jejuno-jejunostomy for Roux-en Y reconstruction. As a postoperative course, separated loop method (SL, n=38) was evaluated by comparing pancreatogastrostomy (PG, n=31) and Imanaga method (IM, n=26). Results: On SL, PG and IM cases, the high amylase level in drainage fluid was noted in 2.6%, 6.5% and 19.2%, respectively. The delayed gastric emptying was seen in PG and IM, but not in SL. Serum albumin levels were similar, but cholinesterase and total cholesterol levels were significant better in SL. Conclusions: SL method is safe for complications after PD.