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Abstract
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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References
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Article info
Publication history
Received:
December 30,
1944
Footnotes
☆Presented at the Fifty-Second Annual Meeting of the Western Surgical Association, Chicago, Ill., Dec. 1 and 2, 1944.
Identification
Copyright
© 1945 Published by Elsevier Inc.
