Isolated roux loop pancreaticojejunostomy vs single loop pancreaticojejunostomy after pancreaticoduodenectomy.

Background: Pancreatic anastomotic leaks are a major cause of morbidity and mortality following pancreaticoduodenectomy, and no single technique of reconstruction has shown to be superior. The aim of this study was to review the experience of single loop versus isolated Roux loop pancreaticojejunostomy in a series of patients undergoing pancreatic head resection.

Methods: A retrospective review involving 111 patients who underwent pancreatic head resections over 13year period (1994-2006) for malignant (n=106) and benign (n=5) disease was performed. Reconstruction of the pancreatic remnant was done using a single loop in 51 patients and by an isolated Roux loop in 60 patients. All pancreatic anastomosis were performed as a duct to mucosa anastomosis, in two layers, with pancreatic stent and closed suction drainage. Pancreatic fistula was defined as drainage of greater than 50ml of amylase rich fluid for more than 7days postoperatively.

Results: The two groups were comparable as regards to their demographic profiles, preoperative laboratory values and disease status in terms of pathology, pancreatic texture and pancreatic duct diameters. The overall incidence of pancreatic anastomotic leak was 11% (12) and was similar in both the groups; single loop 12% (6) and isolated Roux loop 10% (6). Isolated Roux loop pancreaticojejunostomy was associated with a significant prolongation of operative time (7.25+/-1.14h vs 6.07+/-1.12h) (p<0.05) and the need for more blood transfusion (2.25+/-0.84units vs 2.62+/-0.69units) (p<0.05). There was no significant difference in the morbidity or mortality between the two groups. Forty five percent (23) patients had complications in the single loop group and 48% (29) patients had complications in the isolated group. There were 8% (4) death in the single loop group and 8% (5) in the isolated group (p>0.05).

Conclusion: There does not appear to be a significant difference in the rates of pancreatic fistula following either method of reconstruction. However, performance of an isolated Roux loop pancreaticojejunostomy entails a prolongation of operative time and more intraoperative requirement of blood transfusions.