METHOD FOR TOTAL EXTERNAL DRAINAGE OF PANCREATIC DUCT WITH PANCREATODUODENECTOMY

摘要

A method for total external drainage of pancreatic duct with pancreatoduodenectomy involves the removal of the gastropancreatoduodenal complex and the original formation pankreatojejunoanastomy on a "flow-to-mucosa" after the formation of the rear outer and inner layers of the anastomosis. A metal probe 3 mm in diameter and 14 cm long is inserted through the anastomotic opening in the small intestine to the branch pancreatojejunoanastomosis intestine in distal direction; on the route of the probe movement along the antimesenteric edge of the branch intestine a hole is made having a diameter of 3 mm. A drainage is attached to the distal end of the probe to drain the entire pancreatic duct and withdraw the drained substance via the probe to the small intestine anastomotic opening. Then the probe is disconnected from the drainage and the drainage is immersed in a common pancreatic duct, fixed to the intestinal mucosa in pancreatojejunoanastomosis area by a size 5-0 monofilament dissolving thread in one seam. The formation of pancreatojejunoanastomosis is completed by overlaying the inner and outer layers of the front seams. After completion of gastroentero- and hepaticojejunostomy, the drainage is immersed to the length of 6cm in the front surface of the small intestine according to Witzel method and then terminated at the abdominal wall in the left subcostal area. Externally, the drainage is fixed to the skin, from the inside the small intestine is fixed in the drainage area with 4 interrupted sutures according to the anterior abdominal wall. The drainage will not be removed earlier than on the 5th day providing there is no signs of pancreatojejunoanastomtic leak; to remove the drainage the external suture fixing it to the skin is cut, and an aseptic bandage is applied to the counteropening zone.