Pancreaticoduodenectomy with closing the pancreatic stump versus standard Whipple’s procedure: A nonanastomotic technique in surgery of pancreatic cancers

Abstract Background/Aims. Pancreaticoduodenectomy is commonly used for the surgical treatment of malignancies of the ampulla of Vater, duodenum, head of pancreas, and distal common bile duct (CBD). Pancreatic fistula and anastomotic leakage are the common fatal complications of the procedure. Management of the remained stump is the most important part of pancreaticoduodenectomy in the prevention of fistula and leakage. We describe a nonanastomotic procedure that has fewer complications. Methods. Wirsung’s duct was ligated with interrupted sutures after pancreaticoduodenectomy. The cut edge of the pancreatic stump was then sutured. Drainage of the stump field was performed with a Petzer drain. Results. Of the six patients who were studied, three were men and three were woman. The mean age was 59.19 years. There were no serious problems with pancreatic fistula, anastomotic leakage, significant weight loss, far elevation in serum amylase, pancreatitis, and oral intake within the follow-up months (median = 7 months, minimum = 2 months, maximum = 20 months). Conclusion. Such nonanastomotic options necessitate the use of pancreatic enzyme supplementation, but low rate of complications and simple procedure can present it as an operation of choice.