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Chapter-04 Management of Pancreatic Remnant after Pancreaticoduodenectomy

BOOK TITLE: Gastrointestinal Surgery Series: Pancreas and Hepatobiliary Surgery

Author
1. Tewari Mallika
ISBN
9789352702602
DOI
10.5005/jp/books/14149_5
Edition
1/e
Publishing Year
2018
Pages
21
Author Affiliations
1. Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Chapter keywords
Pancreaticoduodenectomy, PD, pancreaticojejunostomy, PJ, pancreatic remnant, duct-to-mucosa pancreaticogastrostomy, DMPG, binding pancreaticojejunostomy

Abstract

This chapter summarizes some of the important techniques of management of the pancreatic remnant after pancreaticoduodenectomy (PD) and also provides a glimpse of the history of how pancreatic surgery has evolved to its present state. Pancreatic remnant after PD essentially comprises of body and tail of the pancreas. Exocrine secretions of the remnant pancreas are drained into the jejunum or stomach in an attempt to save the glands’ exocrine and endocrine functions. The evolution of management of pancreatic remnant has evolved paripassu with the evolution of PD over ages. Codivilla has been recognized as the pioneer of PD. Pancreaticojejunostomy (PJ) has rightly been described as the ‘‘Achilles heel’’ of PD, as the failure of the anastomosis is often fatal. PJ is commonly favored by most surgeons but several studies have reported a high-anastomotic leak rate when performed using the traditional technique. Technique of pancreaticojejunostomy based on vascular supply of pancreas is also discussed in this chapter.

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