Abstract
This single center study evaluated the technical modifications and outcome of reconstruction after pancreaticoduodenectomy for trauma. Prospectively recorded data including reconstructive techniques used in patients who underwent a pancreatoduodenectomy (PD) for trauma were analyzed. Twenty patients underwent a PD. Six had an initial damage control procedure. Thirteen had a pylorus-preserving PD and 7 a standard Whipple resection because injury to the pylorus precluded a pylorus-preserving resection. Twelve patients had a pancreatojejunostomy and 8 a pancreatogastrostomy, 3 of whom had a duodenojejunal hepaticojejunal sequence of anastomoses to allow endoscopic biliary stent retrieval. Three patients died postoperatively of multi-organ failure. All 17 survivors had postoperative complications: 5 patients developed pancreatic fistula, 2 had gastric outlet obstruction, 2 had bile leaks, 2 had duodenal anastomotic leaks, all of which resolved with conservative treatment. Pancreatic and biliary reconstructions performed under adverse conditions after a trauma PD required a variety of technical modifications. The pylorus does not have to be sacrificed and posterior gastric implantation is a safe option for an edematous pancreas.