To investigate the effect of modified pancreatico-jejunal and gastrointestinal anastomosis for short- and long-term complications after pancreaticoduodenectomy.

Digestive tract was rebuilt in fifty-two patients undergoing pancreaticoduodenectomy in the order of pancretico-jejunal, biliary ductal junction and gastrointestinal anastomosis. After pancreaticoduodenectomy, the pancreatic stump was freed from the surrounding vessels and structures for a length of 2.5-3.0 cm. A jejunal loop was prepared for the pancreatico-jejunal anastomosis by removing the seromuscular layer where it would be anastomosed. The length of intestinal mucosal flap corresponded to anteroposterior diameter of pancreatic stump. An end to end pancreatico-jejunal anastomosis was then performed for covering surface of pancreatic stump with intestinal mucosal flap and duct-to-mucosal anastomosis. Gastrointestinal anastomosis was carried out in the 30 cm between the gastric-remnant or duodenal bulb and pancreatic biliary side bowel loops.

Two cases (3.8%) of pancreatic leakage were observed, and were cured by administration of adequate drainage, somatostatin, enteral nutrition and so on. Postoperative serious complications such as abdominal infection or heavy bleeding were not observed. For a three-year follow-up, the rate of generally normal digestion and absorption function was 95.0% (38/40). All the patients were free from the long-term complications, like retrograde infection of biliary tract, bile reflux gastritis or gastrointestinal anastomotic ulcer.

Pancreatico-jejunal invagination anastomosis may reduce short-term complications of potential anastomotic, covering surface of pancreatic stump with intestinal mucosal flap and duct-to-mucosal anastomosis in alimentary tract reconstruction. Jejunal interposition between the gastric-remnant or duodenal bulb and pancreatic biliary side bowel loops in the reconstruction of gastrointestinal tract can reduce the incidence of long-term complications caused by gastrointestinal reflux.