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Summary  Several exocrine drainage procedures have been successfully developed to perform pancreas transplantation ( PT ). Retroperitoneal graft placement allows exocrine drainage via direct duodenoduodenostomy ( DD ). This technique provides easy access for endoscopic surveillance and biopsy. A total of 241  PT  procedures were performed in our centre between 2002 and 2012.  DD  was performed in 125 patients, and duodenojejunostomy ( DJ ) in 116 patients. We retrospectively compared our experience with these two types of enteric drainage, focusing on graft and patient survivals, as well as postoperative complications. With a mean follow‐up of 59 months, both groups demonstrated comparable patient and graft survivals. 14 (11%) of 125 cases in the  DD  group and 21 (18%) of 116 cases in the  DJ  group had pancreatic graft loss ( P  = 0.142). Graft thrombosis [5 (4%) vs. 18 (16%)  P  = 0.002], anastomotic insufficiency [2 (1.6%) vs. 8 (7%)  P  = 0.052] and relaparotomy [52 (41%) vs. 56 (48%)  P  = 0.29] occurred more frequently in the  DJ  group, whereas gastrointestinal bleeding [14 (11%) vs. 4 (3%)  P  = 0.026] occurred more often in the  DD  group.  DD  is a feasible and safe technique in  PT , with no increase in enteric complications. It is equivalent to other established techniques and extends the feasibility of anastomotic sites, especially in recipients who have undergone a second transplantation.

125 Cases of duodenoduodenostomy in pancreas transplantation: a single‐centre experience of an alternative enteric drainage