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Leakage of the pancreaticojejunal anastomosis is a serious complication after pancreaticoduodenectomy. External drainage of the pancreatic remnant is one of several methods for reducing pancreaticojejunal anastomotic leakage or fistula. We investigated complications after pancreaticoduodenectomy with and without external drainage of the pancreatic remnant. METHODS: Patients who underwent pancreaticoduodenectomy at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from November 1991 to October 2007 were enrolled. Before 2001, no external pancreatic drainage was employed during pancreaticojejunal anastomosis (non-stented group). Since 2001, external drainage of the pancreatic remnant has been routinely performed with a paediatric feeding tube (stented group). RESULTS: There were 28 patients in the non-stented group and 45 in the stented group. Stented patients had undergone significantly more previous abdominal operations, pylorus preserving pancreaticoduodenectomy, and end to end anastomosis of the pancreatic remnant and jejunal limb. Leakage of the pancreaticojejunal anastomosis or pancreatic fistula, overall complications, and re-laparotomy rate were significantly higher in the non-stented group (leakage or fistula 21.4% vs. 6.7%, overall complications 50% vs. 33.3%, and re-laparotomy 18% vs. 2.2%). The only death was in the non-stented group. CONCLUSION: External drainage of the pancreatic remnant after pancreaticoduodenectomy is an effective method for prevention of pancreaticojejunal anastomosis leakage and other related complications.

Background: The spleen is one of the most commonly injured organs following abdominal trauma. A widespread shift to non-operative management (NOM) for splenic injuries has been observed in most centers worldwide. Thus, the purpose of this study is to report our experience in treating patient with splenic injuries with NOM at a King Chulalongkorn Memorial Hospital. Objective: The aim of this study is to describe the demographics, mechanisms of injury, management and outcomes in patients who suffered splenic trauma in King Chulalongkorn Memorial Hospital. Materials and Methods: A retrospective study included all splenic injury patients admitted to King Chulalongkorn Memorial Hospital between January 2009 and January 2019. Results: A total of 106 patients were included, with a median age of 31.5 years. Of these, 91 patients (85.8%) had blunt injuries. Fifty-seven (59.8%) had high-grade injuries. A total of 43 (40.6%) patients were managed with observation, 1 (2.3%) patient had radiological intervention, 4 (3.7%) patients were managed with splenic salvage operation and 59 (55.7%) patients had splenectomy. Patients who died were significantly more likely to be multiple organ injuries. Conclusion: Splenic injuries have shown a steady increase in the last decade. Splenectomy rates have decreased in favor of non-operative techniques. Radiological intervention with splenic artery embolization was successful in all selected patients with high-grade injuries. [ABSTRACT FROM AUTHOR]