Pancreaticoduodenectomy and external Wirsung stenting: Our outcomes in 80 cases

• Published in: Cirugia española (English ed.) 2021-06, Vol.99 (6), p.440-449
• Main Authors: Jiménez Romero, Carlos, Alonso Murillo, Laura, Rioja Conde, Paula, Marcacuzco Quinto, Alberto, Caso Maestro, Óscar, Nutu, Anisa, Pérez Moreiras, Isabel, Justo Alonso, Iago
• Format: Article
• Language: English
• Subjects: Duodeno-pancreatectomía cefálica; Duodeno-pancreatectomía de Whipple; External pancreatic duct stenting; External Wirsung duct stenting; Fístulas pancreáticas; Pancreas head tumors; Pancreatic fistula; Pancreaticoduodenectomy; Tumores cabeza de páncreas; Tutorización pancreática externa; Tutorización pancreática externa del Wirsung; Whipple procedure
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2021.05.011

[Display omitted] There is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique. A retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting. Mean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2%, 53.6% and 19.2%, respectively. Although our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy. Existe controversia respecto a la técnica ideal de reconstrucción pancreático-yeyunal pos-resección duodeno-pancreática. La tutorización externa del Wirsung se ha considerado por muchos autores como una técnica con menor incidencia de fístulas y morbi-mortalidad. Analizamos nuestra experiencia con esta técnica. Análisis retrospectivo de la morbi-mortalidad de una serie de 80 pacientes consecutivos intervenidos, durante 6,5 años, por tumores pancreáticos cefálicos o periampulares realizando resección y pancreático-yeyunostomía con tutorización externa del Wirsung. La edad media de los pacientes fue 68,3 ± 9 años y la tasa de resecabilidad del 78%. La consistencia del páncreas era blanda en 51,2% de pacientes y dura en 48,8%. Se preservó el píloro en 43,8%. El tumor más frecuente fue el adenocarcinoma (68,8%) y se consig