ABSTRACT
Surgery remains the main-stay therapy for periampullary carcinoma [PC] and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased the survival. We evaluate the safety and feasibility of 3 reconstruction methods of pancreatic remnant after Pancreatoduodenectomy [PD] such as Telescoping, Duct-to-mucosa pancreaticojejunostomy or pancreaticogastrortomy. This is Comparative prospective study of reconstruction methods of pancreatic remnant after PD was conducted on periampullary carcinoma patients admitted to South Egypt Cancer Institute from Nov.2008 to July 2012. Forty -one patients with periampullary carcinoma consisted of 23 men and 18 women with age ranged between 17-70 years, with a median age of 56 years. Characteristics of patients in the three groups were compared with Chi-square test. A variable was analysed with the Logistic Regression test. Survival rate was analyzed by use Kaplan-Meier test. P-value < 0.05 was considered statistically significant. 9 patients underwent duct-to-mucosa PJ, 17 patients Telescoping of pancreas into the jejunum and 15 patients PG, 30 stenting of pancreatic duct. There was a significant difference between 3 variable methods of reconstruction in leakage rate, operative time, technical difficulty and between stenting and non stenting pancreatic duct. Duct-to-mucosa PJ was least leakage rate, least post operative complication but associated with the longer reconstructive time and same resection time and it was the somewhat difficult. Duct-t-mucosa-PJ safe, least leakage, least blood loss; however PG is associated with more functional deterioration