Pancreatic anastomosis in Whipples - Forum

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Pancreatic anastomosis in Whipples - Ärzteforum

Post#1 »

Putting the pancreas into the back of the stomach does make the plumbing simpler, though I find I always end up doing an anterior gastrotomy to make sure the pancreas really is in the right place. That make the stitching easier - always a problem with the pancreas as it is often rather friable. I just stuff it into the stomach about 1cm, and then suture full thickness stomach to the pancreas with fairly thick bites of continuous 2/0 vicryl. I do it first as it is the most tricky anastamosis and by far the most likely to kick you in the teeth when you least expect it. The order of the rest to my mind is however it lies nicest. I have only a very limited experience with Whipples as most of my patients come too late for such a radical op, and would be interested to hear of our more experienced colleagues' findings. As to long term results I haven't looked either recently but believe it to be at least as good and probably superior. The crux is how it does in your hands and not some fundi in a megacentre who does 5 per week. My last patient perished from a leak at just that anastamosis, though I like to blame the ICU which removed the NGT at day one which I had carefully placed past all the anastamoses so I could feed him early should he get problems, and the fact we ran out of TPN, and a few other things including taking 3 months to get to hospital and almost another month for surgery (he landed in medicine). Such are the problems of the public sector here - black patients take long to get here out of ignorance, and white patients out of fear take even longer. I am still asked if my hospital is for blacks only.

Yes I do get overtime. If it stops I am quite prepared to strike over the issue - a more honest policy I think than simply slipping off elsewhere as we in the profession have tended to do. I would like to go down fighting and with a big noise rather than see public sector medicine fail because the terms and conditions of service for skilled professionals are so bad no one will work there. I certainly think it a worthier cause for the association of surgeons to take up than all the fuss about private fees for the bloated private sector here.


Re: Pancreatic anastomosis in Whipples - Ärzteforum

Post#2 »

Friable pancreas not securely holding sutures is an indication for total pancreatectomy, as you are doing gastric anastomosis the exocrine functions of pancreatic remnant will be compromised being secreted in acid medium.

I do end-to-end invaginating ( dunking) pancreatico-jejunal anastomosis, most of the patients will develop pancreatic leakage in the early post operative period, which usually stops spontaneously around the 10 Th. post operative day, my last patient, a 70 yo male had a Whipple tree weeks ago for a moderately differentiated adenocarcinoma of the papilla of Vater with negative nodes, had an initial high out put from the left side intraabdominal drain, about 400 ml/day of a very high amylase clear fluid, after one week I started him on Octreotide (Sandostatin) 100 microgram Q 8 h S.C., today he is putting 80 ml but he started to develop nausea and vomiting of small amounts of greenish fluid, he is on jejunal feeding, so I stopped the Octreotide today. I don't know if this fistula is going to close or not.

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