Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 5 Advantages and disadvantages of enteric drainage of the exocrine secretions

Advantages

Safety

Lower rates of urinary tract infections and urologic complications

More “physiologic”; fewer metabolic and volume problems

Fewer readmissions

Technical considerations

Treats exocrine insufficiency (in patients following total pancreatectomy or in patients with cystic fibrosis

Avoidance of need for enteric conversion; lower relaparotomy rate

Can be used with either systemic or portal venous outflow

Disadvantages

Safety

Higher incidence of leakage of pancreatic enzymes, pancreatitis, peri-pancreatic fluid collections

Higher incidence of intra-abdominal abscess, peritonitis, sepsis

Anastomotic leaks, GI bleeding

Increased risk of wound infections, wound healing problems (contaminated case with GI tract breach)

Technical considerations

Selective need for enterolysis or diverting Roux en y limb

Loss of direct access to anastomosis and allograft for diagnosis and treatment

Miscellaneous problems

Inability to directly monitor exocrine secretions

GI: Gastrointestinal.