Wirsung Duct Occlusion Versus Pancreaticojejunostomy after Pancreaticoduodenectomy

Abstract Background: Postoperative pancreatic fistula is still a cause of major morbidity after pancreaticoduodenectomy. The optimal management of the pancreatic remnant is still controversial. Our aim was to analyze the role of two different procedures in the management of pancreatic stump in a single surgical unit. Methods: We report our experience on 40 consecutive patients who underwent pancreaticoduodenectomy over a 6-year period and compare results between occlusion of the pancreatic duct and pancreaticojejunostomy. Results: A total of 40 patients who underwent pancreaticoduodenectomy were included in the study, 20 with a pancreaticojejunostomy and 20 with chemical occlusion of the pancreatic duct. Patient’s characteristics, operative and recovery data were similar between groups. The most frequent postoperative complication was pancreatic fistula; although incidence rate was higher in the duct occlusion group the difference was not statistically significant. Conclusions: There is no agreement on the optimal approach to the pancreatic stump after pancreaticoduodenectomy. Pancreaticojejunostomy is still the procedure of choice but further large randomized trials are needed to compare different methods of pancreatic remnant management. Nevertheless, it seems wise for pancreatic surgeons as well as general surgeons to be able to perform more than one technique to offer the patient higher probability of success. Keywords Pancreatic duct occlusion, Pancreaticoduo