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