The Obituary of the Pylorus-Preserving Pancreatoduodenectomy

Torres, Orlando Jorge Martins; Vasques, Rodrigo Rodrigues; Torres, Camila

doi:10.1590/0102-6720201600020001

Cited by 3 publications

(3 citation statements)

References 9 publications

(29 reference statements)

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“…In the current study, we observed that the classic Whipple procedure was performed by 46.2% (24 surgeons), pylorus preserving by 28.8% (15), and SSPPD by 17.3% (nine). SSPPD is evolving worldwide, preserving the stomach and supporting the evidence that the pylorus is related to complications such as delayed gastric emptying, postoperative malnutrition at one year, and incomplete lymphadenectomy in up to 9.0% of patients 15,21,41 . Recently introduced in Brazil, SSPPD is gradually replacing the two previous procedures.…”

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 88%

Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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-Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy.

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Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 88%

Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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“…After the resection phase by subtotal stomach-preserving pancreatoduodenectomy, the technique is completed and the specimen is retrieved. Then, a jejunal single limb is moved to the pancreatic cut end by a trans-mesocolic route and prepared for the anastomosis 15 . …”

Section: Methodsmentioning

confidence: 99%

Modified Heidelberg Technique for Pancreatic Anastomosis

Torres

Costa

et al. 2017

ABCD, arq. bras. cir. dig.

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Background : Pancreatic fistula is a major cause of morbidity and mortality after pancreatoduodenectomy. To prevent this complication, many technical procedures have been described. Aim: To present a novel technique based on slight modifications of the original Heidelberg technique, as new pancreatojejunostomy technique for reconstruction of pancreatic stump after pancreatoduodenectomy and present initial results. Method: The technique was used for patients with soft or hard pancreas and with duct size smaller or larger than 3 mm. The stitches are performed with 5-0 double needle prolene at the 2 o’clock, 4 o’clock, 6 o’clock, 8 o’clock, 10 o’clock, and 12 o’clock, positions, full thickness of the parenchyma. A running suture is performed with 4-0 single needle prolene on the posterior and anterior aspect the pancreatic parenchyma with the jejunal seromuscular layer. A plastic stent, 20 cm long, is inserted into the pancreatic duct and extended into the jejunal lumen. Two previously placed hemostatic sutures on the superior and inferior edges of the remnant pancreatic stump are passed in the jejunal seromuscular layer and tied. Results : Seventeen patients underwent pancreatojejunostomy after pancreatoduodenectomy for different causes. None developed grade B or C pancreatic fistula. Biochemical leak according to the new definition (International Study Group on Pancreatic Surgery) was observed in four patients (23.5%). No mortality was observed. Conclusion : Early results of this technique confirm that it is simple, reliable, easy to perform, and easy to learn. This technique is useful to reduce the incidence of pancreatic fistula after pancreatoduodenectomy.

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“…In the current study, we observed that the classic Whipple procedure was performed by 46.2% (24 surgeons), pylorus preserving by 28.8% (15), and SSPPD by 17.3% (nine). SSPPD is evolving worldwide, preserving the stomach and supporting the evidence that the pylorus is related to complications such as delayed gastric emptying, postoperative malnutrition at one year, and incomplete lymphadenectomy in up to 9.0% of patients 15 , 21 , 41 . Recently introduced in Brazil, SSPPD is gradually replacing the two previous procedures.…”

Section: Discussionmentioning

confidence: 87%

Pancreatoduodenectomy: Brazilian Practice Patterns

Torres

Fernandes

Vasques

et al. 2017

ABCD, arq. bras. cir. dig.

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Background:Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim:To understand the Brazilian practice patterns for pancreatoduodenectomy. Method:A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.

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The Obituary of the Pylorus-Preserving Pancreatoduodenectomy

Cited by 3 publications

References 9 publications

Pancreatoduodenectomy: Brazilian practice patterns

Pancreatoduodenectomy: Brazilian practice patterns

Modified Heidelberg Technique for Pancreatic Anastomosis

Pancreatoduodenectomy: Brazilian Practice Patterns

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