Surgical Treatment of the Pancreatic Stump: Comparing Different Techniques

Abstract

The pancreatic stump is the major source of morbidity and mortality of pancreatoduodenectomy (PD). Any surgeon experienced in pancreatic surgery is often dealing with the dramatic consequences of the failure of the technique he or she adopted; thus we ask ourselves what technical errors we have committed, or whether it would have been better to perform a different reconstruction, maybe an anastomosis with the stomach, or an interrupted suture instead of a continuous one, or to use a Roux-en-Y limb, or to close the stump without anastomosis. In these circumstances the questions are many and legitimate, because pancreatic surgery requires an extremely accurate technique and we need to choose the proper solution based on the pancreas’ characteristics and on our own experience. However, it is important, first of all, to realize that the main actor in the dramatic consequences of pancreatic surgery is the pancreas itself, with the destructive potential of its digestive secretions. There is no evidence that any given technique is able to solve the problems of the pancreatic remnant, and no comparative study has proved one specific technique to be clearly better than another. Nevertheless, if our aim is to expose our patient who is a candidate for a PD to the smallest possible risk of death (for that is what is at issue), there is one vital element that is frequently ignored.