Modified pancreaticoduodenectomy: experience with 81 cases, Wahab modification.

Background/Alms: Now pancresticoduodenectomy is censidered a safe and scceptable line of treatment for periampullary tumors, In spite of improvements in the surgical technique it still has a high morbidity rate, In this study we introdoce new technical modificstions for the original procedore aiming to decrease the incldence of morbidity. Methodology: Between 1994-2000, 210 pancreatiecduodenectomies were done in the Gastroenterology Center, Mansura University, Egypt for periampullary tumor, Eighty-one of these patients were subjected to modified pancreaticoduedenectomy sotgected to modified pancreaticoduodenectorsy. They were 57 men and 84 women with a mean age of 54 (±8) years. Pancreatic carcinoma represented 54%, ampullary tumor 38%, bile duct carcinoma 5% and duoderal carcinoma 1.2%. The mean operative time was 3.7±0.5 hours and mean estimated blood loss during surgery was 733±48mL. Results: Hospital mortality occurred in 3.7% with an overall morbidity rate of 32%, The most common complications were delayed gastric emplying 8.9%, pancreatic fistulae 3.8%, wound infection 8.4%, bilary leakage 3.8% and bleeding 5%. The mean post-operative hospital stay was 9.4±1 days, with mean time for starting oral feeding 6±0.9 days. Late mortality occarred in 46% for the entire group with mean fullow-up 22±19 months with actuarial survival for 1, 2, 3, 4, and 5 years being 80, 45, 25, 15, and 10%, respectively. Conclusions: It was found that this new modification made the operation casier with shorter operative time, less bloud transfusion, low incldence of morbidity and short hospital stay. Moreover, it takes the advantages of lowering the incidence of biliary gasritis, cholangitis and peptic olcer.