Digestive enzymes are produced within the pancreatic acinar cells, packaged into storage vesicles called zymogens, and then released via the pancreatic ductal cells into the pancreatic duct. They are then secreted into the small intestine to begin the metabolic process(http://emedicine.medscape.com/article/181364-overview). If it does get to the end side duct, mucosa pancreojejunal anastomosis has high rate of leakage since the outer layer is simply attached to intestinal wall and doesn’t drain to the intestinal lumen. So this is a serious factor that must be take into consideration, as only the end to end pancreatojejunal anastomosis is the safest if the pancreas is soft or hard.
I agree with you. The duct-to-mucosa technique excludes the cut surface of the pancreas from the lumen of the jenunum. I prefer dunking the pancreas into the end of the jejunum. Even if there is a leak it tends to be self limited rather than the kind of disastrous leaks we see with duct-to-mucosa anastomoses.
I think pancreatic surface secrete pancratic juce.The high level of amylase in the peritoneal drainage after Whipple operation suggest this fact.
I do not agree whit you.I used duct-to mucosa anastomosis in the last fifty patients.I have only one type B and ten biochemical (type A ) pancreatic fistula (non publish ).
No doubt concerning enzymes production, but it's not a problem of duct to mucosa or complete pancreas dunking. If the duct to mucosa is the problem how we can explain the lower and almost grade A or B fistula after distal pancreatectomy where almost all surgeons use to close the duct? We use Blumgart's technique and overall fistula' incidence is about 25% but grade C and D fistula is very low. We have to consider how's the parenchyma, if the anastomosis is soft, if the duct is dilated enough or not, general patient situation….