Critical Analysis of a Large Series of Pancreaticogastrostomy After Pancreaticoduodenectomy (original) (raw)
Related papers
Pancreaticogastrostomy following Pancreaticoduodenectomy: Review of 102 Consecutive Cases
World Journal of Surgery, 2001
Disruption of the pancreatic anastomosis with resultant sepsis is the cause of nearly 50% of deaths following pancreaticoduodenectomy (PD). Traditionally, the pancreatic remnant is anastomosed to the jejunum. Pancreaticogastrostomy (PG) was introduced as an alternative by Waugh and Clagett in 1946 and by Park, Mackie, and Rhoads in 1967. The purpose of this retrospective review was to assess the safety of PG at a single institution. Between 1986 and 1998 a total of 102 patients underwent PG following PD. The indications for PD were periampullary carcinoma (n ؍ 89), pancreatitis (n ؍ 7), and miscellaneous (n ؍ 6). Altogether, 80 patients underwent the traditional Whipple procedure and 22 the pylorus-preserving Whipple (PPW) procedure. The PG was performed by a single-layer invagination technique to the posterior gastric wall using interrupted silk sutures. Leaks from the pancreatic anastomosis were detected by measuring amylase in fluid obtained from surgically placed drains. Operative mortality was 3.9% (4/102). The cause of death was uncontrolled upper gastrointestinal hemorrhage, sepsis, pulmonary embolus, and cardiac failure secondary to myocardial infarction. The mean operating time was 6.8 hours. Blood transfusion was given in 43 patients (42%), and the mean amount of the transfusion was 2.6 units. Nonfatal complications occurred in 35 patients (34%), and included leaks from the pancreatic anastomosis in 9 (8.8%), leaks from the biliaryenteric anastomosis in 4 (3.9%), and gastric paresis 7 (6.9%). Other complications included abscess, wound infection, colitis, delirium tremens, and hyperbilirubinemia. Discharge occurred 6 to 47 days (median 12 days) postoperatively and was prolonged in patients suffering from a complication. PD is associated with significant morbidity. PG is a safe alternative to pancreaticojejunostomy for managing the pancreatic remnant.
Journal of Surgery Research and Practice, 2021
Introduction: The postoperative mortality and morbidity after pancreaticoduodenectomy with pancreaticogastrostomy and pancreaticojejunostomy is controversial. Aim of the study: Primary aim was comparison of Post-Operative Pancreatic Fistula (POPF) rate in PG vs PJ. Secondary aim was mortality rate between PG vs PJ. Method: A retrospective analysis of data of 74 patients who underwent pancreaticoduodenectomy with either pancreaticogastrostomy or pancreaticojejunostomy from June 2012 to June 2014. Statistical analysis done using un-paired ‘t’ test, chi square test, fischer’s exact test appropriately.
Annals of Surgery, 1995
The authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy afte pancreaticoduodenectomy and less likely to be associated with a postoperative pancreatic fistula Summary Background Data Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, occurring in 10% to 20% of patients. Nonrandomized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postoperative complications. Methods Between May 1993 and January 1995, the findings for 145 patients were analyzed in this prospective trial at The Johns Hopkins Hospital. After giving their appropriate preoperative informed consent, patients were randomly assigned to pancreaticogastrostomy or pancreaticojejunostomy after completion of the pancreaticoduodenal resection. All pancreatic anastomoses were performed in two layers without pancreatic duct stents and with closed suction drainage. Pancreatic fistula was defined as drainage of greater than 50 mL of amylase-rid fluid on or after postoperative day 10. Results The pancreaticogastrostomy (n = 73) and pancreaticojejunostomy (n = 72) groups were comparable with regard to multiple parameters, including demographics, medical history, preoperative laboratory values, and intraoperative factors, such as operative time, blood transfusions, pancreatic texture, length of pancreatic remnant mobilized, and pancreatic duct diameter. The overall incidence of pancreatic fistula after pancreaticoduodenectomy was 11.7% (17/145). The incidence of pancreatic fistula was similar for the pancreaticogastrostomy (12.3%) and pancreaticojejunostomy (1 1.1 %) groups. Pancreatic fistula was associated with a significant prolongation of postoperative hospital stay (36 ± 5 vs. 15 ± 1 days) (p < 0.001). Factors significantly increasing the risk of pancreatic fistula by univariate logistic regression analysis included ampullary or duodenal disease, soft pancreatic texture, longer operative time, greater intraoperative red blood cell transfusions, and lower surgical volume (p < 0.05). A multivariate 580
Comparison Between Pancreaticojejunostomy and Pancreaticogastrostomy After Pancreaticoduodenectomy
Journal of the Formosan Medical Association, 2007
Pancreaticoduodenectomy (PD) has become increasingly accepted as a safe and appropriate surgical technique for patients with either malignant or benign diseases of the pancreas and periampullary region. Nonetheless, the incidence of postoperative morbidity remains high and is currently estimated at 46-59%. 1-12 In most reports, the leading cause of morbidity after PD is attributable to pancreatic leakage, 1,2,8,13-15 due to failure of the pancreatic-enteric anastomosis to heal. The incidence of pancreatic anastomosis leakages ranges from 6% to 24%, with an average
International journal of surgery (London, England), 2018
The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications. The study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented. There were 60 men and 37 women (mean age was ...
Journal of Gastrointestinal Surgery, 2012
Background Due to improved surgical outcomes and increased detection of pancreatic lesions, the resection of nonmalignant and indeterminate lesions of the pancreas has increased. Aims This study aims to assess the outcomes over an extended period of time and the clinical consequences of pancreaticoduodenectomy (PD) performed for nonmalignant indications. Methods Patients undergoing a PD between 2006 and 2010 were retrospectively identified and asked to complete a symptom survey. Charts were reviewed for hospital admissions, emergency room visits, complications, and procedures performed. Results A total of 132 patients were identified through database review with a median follow-up of 2.8 years. Forty-two patients (31.1%) completed the phone survey. Pain and diarrhea were the most common symptoms reported, negatively impacting the patient's daily life in 4.9% and 7.3% of patients, respectively. Diabetes developed or worsened in 19.5%, with new insulin required in 12.2%. Complications were rare, with abdominal abscess (7.6%) occurring most commonly. Conclusions Although some patients experienced symptoms that negatively impacted their daily life or had diabetic issues following surgery, the outcome of patients undergoing PD for nonmalignant indications was generally favorable. Further prospective study is warranted.
A Comparison of Pancreaticogastrostomy and Pancreaticojejunostomy Following Pancreaticoduodenectomy
Journal of Gastrointestinal Surgery, 2003
This retrospective study compares the results of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) in our institution, which has extensive experience in both techniques. Between the years of June 1995 and June 2001, 214 patients underwent pancreaticoduodenectomy (PD) at our institution. Of these 177 had PG and 97 had pancreatojejunostomy (PJ). There were 117 (54.6%) males and 97 (45.3%) females with a mean age of 64.2 Ϯ 12.4 years. Indications for surgery were pancreatic adenocarcinoma in 101 (47.2%), ampullary adenocarcinoma in 36 (16.9%), distal bile duct adenocarcinoma in 22 (10.2%), duodenal adenocarcinoma in 9 (4.2%), and miscellaneous causes in 46 (21.4%) of patients. Preoperatively, significant differences in the groups were that the patients undergoing PJ were significantly younger than those undergoing PG. Also noted preoperatively, was that the patients undergoing PG had a significantly lower direct bilirubin than those undergoing PJ. With regard to intraoperative parameters, operative time was significantly shorter in the PJ group when compared to the PG group. When the patients who did not develop fistula (N ϭ 186) were compared to those who developed fistula (N ϭ 28) the significant differences were that the patients who developed fistula were more likely to have hypertension preoperatively and a higher alkaline phosphatase. They also showed a significantly higher drain amylase and were likely to have surgery for ampullary, distal bile duct or duodenal carcinoma rather than pancreatic adenocarinoma. In addition, those patients who developed fistula had a significantly longer postoperative stay, a larger number of intraabdominal abscesses and leaks at the biliary anastomosis. Thirty-day mortality was significantly higher in the PJ group compared to the PG (4 vs. 0, P ϭ 0.041). There was a significantly larger number of bile leaks in the PJ group when compared to the PG (6 vs. 1, P ϭ 0.048). In addition, the PJ group required a significantly larger number of new CT guided drains to control infection (8 vs. 2, P ϭ 0.046) and the PJ group required a larger number of re-explorations to control infection or bleeding (5 vs. 0, P ϭ 0.018). However, the pancreatic fistula rate was not different between the two groups (12% [PG] vs. 14% [PJ]). This retrospective analysis shows that safety of PG can be performed safely and is associated with less complications than PJ and proposes PG as a suitable and safe alternative to PJ for the management of the pancreatic remnant following PD. ( J G ASTROINTEST S URG 2003;7:672-682.)
LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group
Arquivos de Gastroenterologia, 2014
Context -Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the "Achilles' heel" of the procedure. Objective -To evaluate the post-operative 30 days morbidity and mortality rates. Methods -Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and datawere obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate). Results -Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusion -The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients. HEADINGS -Pancreatic neoplasms. Pancreaticoduodenectomy. Mortality.
Journal of the College of Physicians and Surgeons Pakistan, 2020
Pancreatic cancer is one of the most aggressive malignancies nowadays. 1 It accounts for 3% of new cases per annum, 2 and it is fourth leading cause of deaths in the west due to malignancy. Pancreatic cancer has a poor prognosis with 5 years survival <5%, 3 despite active surgical treatment. With newer modalities of treatment , outcomes of pancreatic cancer still remain poor and has changed very little in the last three decades. Surgery is the mainstay of treatment; but adjuvant chemotherapy is essential for long term survival. Risk factors for pancreatic cancer are smoking, 4 alcohol, chronic pancreatitis and diabetes mellitus, 5 however exact cause remains unknown. With the advancement of cross-sectional imaging technology, more pancreatic and periampullary tumors are being diagnosed, thus leading to more pancreatic resections. 6,7 Pancreaticoduodenectomy is the surgical procedure of choice for benign and malignant periampullary and pancreatic head tumors. 8 It is a complex surgical procedure associated with major complications including pancreatic fistula, delayed gastric emptying,