Conventional Reconstruction Versus Double Roux Reconstruction Procedure After Pancreaticoduodenectomy

Abstract

Background: Pancreaticoduodenectomy (PD), or the Whipple procedure, is commonly associated with high morbidity. Traditional reconstruction using a single jejunal limb carries risks due to the interaction between pancreatic and biliary secretion. The double roux reconstruction procedure (DRRP) may mitigate these risks. Objectives: We hypothesized that DRRP would reduce postoperative pancreatic fistula and related complications compared to the classic Whipple procedure. Methods: This prospective study included 50 patients (31 classic, 19 DRRP). In DRRP, one Roux limb was used for pancreatic anastomosis, and another for gastrojejunostomy and hepaticojejunostomy. Two drains were placed near each anastomosis and removed once biliary and pancreatic secretions decreased to < 10 mL/day for two consecutive days. Results: The DRRP group had a lower, though not statistically significant, rate of postoperative pancreatic fistula (POPF, 5.3% vs. 16.1%). Reoperation rates were higher in the DRRP group (26.3% vs. 9.7%). Conclusions: The DRRP may reduce certain risks but is associated with specific challenges such as anastomotic leaks and port thrombosis, emphasizing the need for careful patient selection, and further investigations for establishing its benefits definitively.