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Fig. 7.6. Pancreaticoduodenal allograft with exocrine enteric-drainage and venous systemic drainage.

Enteric drainage of the pancreas allograft is physiologic with respect to the delivery of pancreatic enzymes and bicarbonate into the intestines for reabsorption. Enterically drained pancreases can be constructed with or without a Roux-en-Y. The enteric anastomosis can be made side-to-side or end-to-side with the duodenal segment of the pancreas. The risk of intra-abdominal abscesses is extremely low and the avoidance of the bladder-drained pancreas has significant implications with respect to the potential complications that include: bladder infection, cystitis, urethritis, urethral injury, balanitis, hematuria, metabolic acidosis, and the frequent requirement for enteric conversion. Currently, approximately 75% of pancreas transplants are performed with enteric drainage and the remainder with bladder drainage. Figures 7.8 and 7.9 show the annual number and relative proportions of recipients with enteric and bladder drainage of the exocrine pancreas allograft according to year and transplant category.

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