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A new operation for resection of the duodenum and head of the pancreas for carcinoma is described. In this procedure a long loop end-to-side anastomosis is made between the stomach and the jejunum distal to the choledochojejunostomy. This secures drainage of the biliary tract proximal to the gastric anastomosis and so avoids the danger attendant upon passage of food over the common duct opening. However, the chief advantage of the technique recommended lies in the requirement of less time for performance of the operation; in our estimation suture lines and anastomoses for resection of the duodenum and head of the pancreas are reduced to a minimum. The jejunum is anastomosed to the cut end of the stomach with the distal end to the greater curvature so that the food passes downward by gravity into the jejunum instead of upward into the jejunum as it must in many operations previously recommended.
The chief purpose of the long loop proximal to the end-to-side gastrojejunostomy is to allow transplantation of the common duct and, if desired, the stump of the pancreas, into the jejunum proximal to the gastric anastomosis. Although to date very few surgeons are transplanting the stump of the pancreas into the intestine, we believe this procedure will in the future be performed more often than it is now. In one of our patients, the pancreatic fistula which followed the resection is still draining seven months after operation although now only a few ounces per day.
Four patients with carcinoma of the head of the pancreas and one with carcinoma of the ampulla of Vater have been subjected to radical resection of the duodenum and head of the pancreas. There has been one fatality.
Since submission of this article for publication a sixth resection has been performed, utilizing the preferred procedure as illustrated in Fig. 2; the stump of pancreas was transplanted into the loop of jejunum. Postoperative convalescence was uneventful but since only six weeks have passed, insufficient time has elapsed to determine ultimate results.
∗Since submission of this article for publication a sixth resection has been performed, utilizing the preferred procedure as illustrated in Fig. 2; the stump of pancreas was transplanted into the loop of jejunum. Postoperative convalescence was uneventful but since only six weeks have passed, insufficient time has elapsed to determine ultimate results.
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Received: December 30, 1944
☆Presented at the Fifty-Second Annual Meeting of the Western Surgical Association, Chicago, Ill., Dec. 1 and 2, 1944.
© 1945 Published by Elsevier Inc.