WAYS TO PREVENT COMPLICATIONS AFTER PANCREATODUODENECTOMY

Pancreatoduodenectomy (Whipple procedure or Kausch-Whipple procedure) is the most radical surgery for oncological diseases of the periampular zone. The level of complications after it remains high even in large specialized centers. The presented research analyzes the immediate and remote results after Whipple’s procedures. These operations were conducted in the Surgical Clinic № 2, on the basis of the Dnepropetrovsk Mechnikov Regional Hospital. All operations were performed at the period from 2008 to 2019. 120 Whipple’s procedures were included to the study including 102 cases when pancreatojejunostomy was applied at the reconstructive stage, and in 18 cases pancreaticogastrostomy was performed. The choice of the pancreatojejunostomy method depended on the transverse size of the isthmus and the body of the pancreas, the diameter of the Wirsung duct. Early postoperative complications were presented by pancreatic fistulas, gastrostasis, pancreatic stump necrosis, internal bleeding from the anastomosis zone, intraperitoneal bleeding, acute early adhesive intestinal obstruction, failure of hepaticojejunostomy. Among them pancreatic fistulas were most often detected - in 25 (20.8 %) patients. Type A was detected in 9 (7.5 %) cases, type B – in 11 (9.2 %) cases, type C – in 5 (4.1 %) cases. The total number of complications after pancreatojejunostomy was 35.3%, after pancreaticogastrostomy – 22.2 %. Late postoperative complications were presented by peptic ulcer after gastroenteroanastomosis and postoperative ventral hernias. Mortality after Whipple’s procedure was 7.5 %. The reduction of the total number of complications and mortality rate after Whipple’s procedure is associated with the state of pancreatic parenchyma, the choice of the pancreatodigestive anastomosis and the accumulation of clinical experience.