A Comparison of Pancreaticogastrostomy and Pancreaticojejunostomy Following Pancreaticoduodenectomy

Aranha, Gerard V.; Hodul, Pamela J.; Golts, Eugene; Oh, Daniel S.; Pickleman, Jack; Creech, Steven

doi:10.1016/s1091-255x(02)00432-8

Cited by 96 publications

(78 citation statements)

References 43 publications

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“…We found a pancreatic fistula in 54% of our patients, a higher percentage than reported by others [4,8,13]. Likely explanations for the high incidence of pancreatic fistula in our study are, first, a definition of pancreatic fistula that relies not only on imaging findings but also on clinical and biologic data and, second, inclusion only of patients with a soft pancreas, a well-recognized risk factor for the development of pancreatic fistula [1,5,7,10,15].…”

Section: Discussionsupporting

confidence: 45%

“…These fistulas usually are diagnosed after the patient resumes oral intake or after hospital discharge and typically necessitate reoperation or readmission for potentially lethal complications, such as arterial hemorrhage and sepsis [1,5,8,20,22]. These observations emphasize the importance of accurate screening for occult pancreatic fistula, particularly among patients at high risk.…”

Section: Discussionmentioning

confidence: 99%

“…Efforts to reduce the incidence of pancreatic fistula have included definition of risk factors [1,7], improvement of surgical technique [8,9], and perioperative administration of somatostatin and its analogues [1,10]. The International Study Group on Pancreatic Fistula has defined pancreatic fistula OBJECTIVE.…”

Section: G a S T R Oi Nt E S T I N A L I M Ag I Ng • O R Ig I N A L Rmentioning

confidence: 99%

“…inserted at the end of pancreaticoduodenectomy by almost all surgeons [18] do not prevent development of complications related to pancreatic fistula, such as the collections and abscesses found in 10-40% of patients [8,[19][20][21]. Moreover, 5-9% of patients need readmission for fistula or abscess because pancreatic fistula was not diagnosed in the immediately postoperative period [18,20,22].…”

Section: Bruno Et Almentioning

confidence: 99%

“…Pancreatic fistula was defined as the presence of at least one of the two following criteria: first, drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content greater than three times the serum amylase activity [11] and, second, anastomotic leakage confirmed at reoperation or percutaneous drainage for major complications, such as abdominal bleeding and sepsis, during the hospital stay or first readmission [1,8,20,22]. First readmission was defined as the first hospitalization for a complication of the initial pancreaticoduodenectomy within 3 months after hospital discharge [24].…”

Section: Definition Of Pancreatic Fistulamentioning

confidence: 99%

See 4 more Smart Citations

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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W175as "drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than three times the serum amylase activity" [11].The overall rate of pancreatic fistula after pancreaticoduodenectomy ranges from 17% in patients in whom the pancreatic remnant has a hard consistency [12] and exocrine pancreatic function and pancreatic juice output are impaired [13] to 25% in cases in which the pancreas is soft [1], that is, the parenchyma is normal [13]. Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region. Although the mortality rate has decreased to approximately 1-2% at high-volume centers, the morbidity rate ranges from 30% to 50% [1][2][3][4]. The two most frequent complications of pancreaticoduodenectomy are delayed gastric emptying and pancreatic fistula. G a s t r oi nt e s t i n a l I m ag i ng • O r ig i n a l R e s e a rc hPancreatic fistula after pancreaticoduodenectomy is a serious complication resulting in prolonged hospital stay, increased costs, readmission, and a mortality rate of 3-9% [5,6]. Efforts to reduce the incidence of pancreatic fistula have included definition of risk factors [1,7], improvement of surgical technique [8,9], and perioperative administration of somatostatin and its analogues [1,10]. The International Study Group on Pancreatic Fistula has defined pancreatic fistula OBJECTIVE. The purpose of this study was to evaluate the sensitivity and specificity of routine performance of CT on postoperative day 7 in patients at high risk of pancreatic fistula after pancreaticoduodenectomy.MATERIALS AND METHODS. Two radiologists analyzed images from CT examinations of 50 patients with soft pancreas 7 days after pancreaticoduodenectomy. Pancreatic fistula was defined at CT as a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis. Clinicobiologic criteria for the diagnosis of pancreatic fistula were drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content more than three times the serum amylase activity. The final diagnosis of pancreatic fistula was rendered on the basis of clinicobiologic data at hospital discharge or at first readmission.RESULTS. At hospital discharge or at first readmission, 27 of 50 patients (54%) had a pancreatic fistula. On postoperative day 7, 30 patients (60%) had a total of 51 fluid collections, and CT showed a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis in 21 of 51 cases. CT had a sensitivity of 63% (17/27 pat...

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: G a S T R Oi Nt E S T I N A L I M Ag I Ng • O R Ig I N A L Rmentioning

confidence: 99%

Section: Bruno Et Almentioning

confidence: 99%

Section: Definition Of Pancreatic Fistulamentioning

confidence: 99%

See 3 more Smart Citations

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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Management of Pancreatic Fistulas After Pancreaticoduodenectomy

Kazanjian

Hines²,

Eibl³

et al. 2005

Arch Surg

147

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Critical Analysis of a Large Series of Pancreaticogastrostomy After Pancreaticoduodenectomy

2006

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Hypothesis: Pancreaticogastrostomy is a safe operation for a variety of periampullary conditions. Design: Retrospective review of a prospectively collected database. Setting: An academic tertiary care university hospital and a Veterans Affairs hospital. Patients: A total of 235 consecutive patients who underwent pancreaticogastrostomy. Main Outcome Measures: Indications for surgery, preoperative risk factors, intraoperative and postoperative variables, and factors that affect postoperative complications. Results: The most common initial symptoms were jaundice (73.2%), weight loss (23.8%), and abdominal pain (17.0%). The 4 most common indications for surgery were pancreatic adenocarcinoma (41.3%), ampullary carci

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A Comparison of Pancreaticogastrostomy and Pancreaticojejunostomy Following Pancreaticoduodenectomy

Cited by 96 publications

References 43 publications

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Management of Pancreatic Fistulas After Pancreaticoduodenectomy

Critical Analysis of a Large Series of Pancreaticogastrostomy After Pancreaticoduodenectomy

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