Background Pancreaticojejunostomy, an independent risk factor for pancreatic fistula, is the cause of several postoperative complications of pancreaticoduodenectomy. As suturing in minimally invasive surgery is difficult to perform, more simplified methods are needed to guarantee a safe pancreatic anastomosis. The concept of “biological healing” proposed in recent years has changed the conventional understanding of the anastomosis, which recommends rich blood supply, low tension, and loose sutures in the reconstruction of the pancreatic outflow tract. Methods A literature search was conducted in PubMed for articles on pancreaticojejunostomy published between January 2014 and December 2021. After following a due selection process, several techniques developed in accordance with the concept of biological healing that were found suitable for minimally invasive surgery and their related clinical outcomes were described in this review. Results The incidence of clinically relevant pancreatic fistula associated with the presented techniques did not exceed 15.9%, indicating superior results compared to Cattell–Warren double-layer duct-to-mucosa anastomosis (incidence: approximately 20%). The features and drawbacks of these approaches have been enumerated from the viewpoint of biological healing. Conclusions This review described several modified pancreaticojejunostomy techniques with the advantages of a simplified procedure and a lower incidence of pancreatic fistula. Surgeons can choose to apply them in clinical practice to improve patient prognosis.
BackgroundPancreatic stenting is a common method to prevent pancreatic anastomosis stricture and pancreatic fistula after pancreaticoduodenectomy, pancreatectomy, and other pancreatic surgeries. Since the decomposition and digestive ability of pancreatic juice is strong, there is reportedly a low risk of stone formation in the tube. Case presentationA 68-year old female patient who was diagnosed with a pancreatic space occupying lesion was admitted to our department. Central pancreatectomy was performed with the insertion of an internal pancreatic stent, and the patient recovered well postoperatively. However, she was hospitalized again 1 year later with complains of exudation from the abdominal incision. Detailed clinical, imaging, and laboratory examinations revealed multiple stones in the pancreatic stent, which was the major cause of a pancreatic pseudocyst and pancreatitis. During the operation, we anastomosed the cyst to the jejunum and inserted another pancreatic stent without fixation in case of an anastomosis stricture or recurrence of pancreatic stones occurs. The patient was discharged 7 days postoperatively and no other complications were reported during the patient’s follow-up visit half a year later.ConclusionWe described a rare case of postoperative pancreatic stent stones complicated by chronic pancreatitis and pancreatic pseudocyst after central pancreatectomy. Application of pancreatic stent should be carefully evaluated considering its potential complication presented in this report.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.