The thickness of pancreatic transection line as a risk factor for postoperative pancreatic fistula after distal pancreatectomy using the stapler (original) (raw)
Related papers
2005
Background: Only 2 large (more than 100 patients) prospective trials comparing pancreatogastrostomy (PG) with pancreatojejunostomy (PJ) after pancreatoduodenectomy (PD) have been reported until now. One nonrandomized study showed that there were less pancreatic and digestive tract fistula with PG, whereas the other, a randomized trial from a single high-volume center, found no significant differences between the two techniques. Methods: Single blind, controlled randomized, multicenter trial. The main endpoint was intra-abdominal complications (IACs). Results: Of 149 randomized patients, 81 underwent PG and 68 PJ. No significant difference was found between the two groups concerning preor intraoperative patient characteristics. The rate of patients with one or more IACs was 34% in each group. Twenty-seven patients sustained a pancreatoenteric fistula (18%), 13 in PG (16%; 95% confidence interval [CI] 8 -24%) and 14 in PJ (20%; 95% CI 10.5-29.5%). No statistically significant difference was found between the 2 groups concerning the mortality rate (11% overall), the rate of reoperations and/or postoperative interventional radiology drainages (23%), or the length of hospital stay (median 20.5 days). Univariate analysis found the following risk factors:
Journal of Clinical Medicine, 2021
Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which is the best reconstruction method for the treatment of the pancreatic remnant after PD is still a matter of debate. The aim of this study was to retrospectively analyze the morbidity rate in 100 consecutive PD reconstructed with Wirsung-Pancreato-Gastro-Anastomosis (WPGA), performed by a single surgeon applying a personal modification of the pancreatic reconstruction technique. Methods: During an 8-year period (May 2012 to March 2020), 100 consecutive patients underwent PD reconstructed with WPGA. The series included 57 males and 43 females (M/F 1.32), with a mean age of 68 (range 41–86) years. The 90-day morbidity and mortality were retrospectively analyzed. Additionally,...
Pancreaticogastrostomy After Pancreatoduodenectomy
HPB Surgery, 1992
The aim of this study was to evaluate the place of pancreaticogastrostomy (PG) in reducing pancreatic fistula after pancreatoduodenectomy. From January 1988 to June 1991, 32 consecutive patients (mean age, 57 years) were operated on, 25 for malignant disease (78%). The pancreatic remnant was normal in 17 patients (53%) and sclerotic in the others. There was one operative death (3.1%) unrelated to PG. Post-operative complications occurred in five patients (16%). Only two complications were related to PG: 1 patient had anastomotic intra-gastric bleeding and was reoperated on, 1 patient with a normal pancreatic remnant developed a pancreatic fistula (3.1%) treated conservatively.
Innovations in pancreatic anastomosis technique during pancreatoduodenectomies
Langenbeck's Archives of Surgery, 2020
Purpose Pancreatic fistula following pancreatic resections is still a relevant complication. The present work shows the efforts of a single institute to decrease this problem. Methods A total of 130 patients (63 men, 67 women) with a mean age of 60 (range: 23–81) years were operated on between January 2013 and March 2020. The most frequent type of pancreatic resection was a Whipple procedure with partial antrectomy. During all operations, an innovative method was used, namely a modification of the purse-string suture pancreatojejunostomy. Moreover, an early drain removal policy was applied, based on the drain amylase level on the first and subsequent postoperative days. Results Mean postoperative hospital stay was 13 days (range: 7–75). The overall morbidity rate was 43.8%; the clinically relevant (grade B/C) pancreatic fistula (CR-POPF) rate was 6.9%. Delayed gastric emptying (DGE) was observed in 4% of the patients. The ratio of operative mortality was 0.7%; the reoperation rate w...
Reconstruction by Pancreaticojejunostomy Versus Pancreaticogastrostomy Following Pancreatectomy
Annals of Surgery, 2005
To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting. Summary Background Data: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out. Methods: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). Results: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P ϭ not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P ϭ 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P ϭ not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P ϭ 0.01), delayed gastric emptying (P ϭ 0.03), and biliary fistula (P ϭ 0.01). The mean postoperative hospitalization period stay was comparable in both groups. Conclusions: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastros-tomy is associated with a significantly lower frequency of multiple surgical complications.
Antecolic Versus Retrocolic Route of the Gastroenteric Anastomosis After Pancreatoduodenectomy
Annals of Surgery, 2014
Objective: To investigate the relationship between the route of gastroenteric (GE) reconstruction after pancreatoduodenectomy (PD) and the postoperative incidence of delayed gastric emptying (DGE). Background: DGE is one of the most common complications after PD. Recent studies suggest that an antecolic route of the GE reconstruction leads to a lower incidence of DGE, compared to a retrocolic route. In a nonrandomized comparison within our trial center, we found no difference in DGE after antecolic or retrocolic GE reconstruction. Methods: Ten middle-to high-volume centers participated in the patient inclusion. Patients scheduled for PD who gave written informed consent were included and randomized during surgery after resection. Standard operation was a pylorus-preserving PD. Primary endpoint was DGE. Secondary endpoints included other complications and length of hospital stay. Results: There were 125 patients in the retrocolic group, and 121 patients in the antecolic group. Baseline and treatment characteristics did not differ between the study groups. In the retrocolic group, 45 patients (36%) developed clinically relevant DGE compared with 41 (34%) in the antecolic group (absolute risk difference: 2.1%; 95% confidence interval: −9.8% to 14.0%). There were no differences in need for postoperative (par)enteral nutritional support, other complications, hospital mortality, and median length of hospital stay.
Surgery, 2016
Clinically relevant postoperative pancreatic fistula (grades B and C of the ISGPS definition) remains the most troublesome complication after pancreatoduodenectomy. The approach to management of the pancreatic remnant via some form of pancreatico-enteric anastomosis determines the incidence and severity of clinically relevant postoperative pancreatic fistula. Despite numerous trials comparing diverse pancreatico-enteric anastomosis techniques and other adjunctive strategies (pancreatic duct stenting, somatostatin analogues, etc), currently, there is no clear consensus regarding the ideal method of pancreatico-enteric anastomosis. An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the best contemporary literature concerning pancreatico-enteric anastomosis and worked to develop a position statement on pancreatic anastomosis after pancreatoduodenectomy. There is inherent risk assumed by creating a pancreatico-enteric anastomosis based on f...
Erciyes Medical Journal, 2022
Despite advanced new anastomosis techniques and auxiliary anastomosis materials, unfortunately, the rate of pancreaticojejunostomy (PJ) anastomotic fistula developing after pancreatoduodenectomy (PD) has not fallen to the anticipated level. The aim of this review was to evaluate different PJ techniques in the context of the current literature. The method used for PJ anastomosis is one of the most critical risk factors. Also, the rate of pancreatic fistula after the operation (PFAO) is exceptionally high in patients with a soft pancreas, narrow pancreatic duct diameter, or a posteriorly located pancreatic duct. Meta-analyses comparing duct-mucosa-PJ (dm-PJ) and invagination-PJ (i-PJ) have demonstrated similar rates of PFAO, morbidity, and mortality. Although a lower rate of PFAO was originally reported when using the binding-PJ approach, recent studies have contradicted this, showing similar rates of PFAO, morbidity, and mortality. A recent meta-analysis comparing Blumgart anastomosis (BA) and conventional pancreaticojejunostomy (c-PJ) reported that BA was significantly associated with a lower grade B/C PFAO ratio. However, in a subgroup analysis, there was no significant impact on grade B/C PFAO in patients with soft pancreatic stumps. The literature also includes reports of internal or external stents and prophylactic octreotide being used to reduce the rate of PFAO. In conclusion, pancreatic fistula development after PD is multifactorial. The surgeon can reduce bleeding and avoid sepsis with meticulous dissection and taking extra care throughout the entire operation. Based on the results of meta-analyses, standard dm-PJ anastomosis and BA techniques performed carefully can be recommended as a standard, leading to a more controlled PFAO rate.
Annals of surgery, 2017
The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy. The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circumstances of the anastomosis. The Fistula Risk Score (FRS) identifies a distinct high-risk cohort (FRS 7 to 10) that demonstrates substantially worse clinical outcomes. The value of various fistula mitigation strategies in these particular high-stakes cases has not been previously explored. This multinational study included 5323 PDs performed by 62 surgeons at 17 institutions. Mitigation strategies, including both technique related (ie, pancreatogastrostomy reconstruction; dunking; tissue patches) and the use of adjuvant strategies (ie, intraperitoneal drains; anastomotic stents; prophylactic octreotide; tissue sealants), were evaluated using multivariable regression analysis and propensity score matching. A...