A Simple, Secure and Universal Pancreaticojejunostomy following Pancreaticoduodenectomy

Lin, Pin–Wen; Lee, J.-C.; Lee, P.-C.; Chang, Ting‐Tsung; Hung, C.-J.; Chang, Yu‐Chung

doi:10.1155/1997/10729

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…All operative procedures were performed by the same surgeon (P.-W.L.) with the same technique, same approach and same anastomotic fashion 15 . In the Whipple pancreaticoduodenectomy, the vagus nerves were preserved and the distal twothirds of the stomach was transected.…”

Section: Methodsmentioning

confidence: 99%

Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy

Lin

1999

Journal of British Surgery

199

135

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In this prospective randomized study, both PPPD and the Whipple procedure were associated with low mortality and operative morbidity rates. There was no significant difference between PPPD and Whipple resection in terms of operative mortality and morbidity, operating time, blood loss and blood transfusion. PPPD was associated with more frequent delayed gastric emptying, although study of more patients is needed to confirm this.

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Section: Methodsmentioning

confidence: 99%

Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy

Lin

1999

Journal of British Surgery

199

135

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“…25 Table 1 lists the results of some major series of pancreaticojejunal anastomoses. 22,[26][27][28][29][30][31][32][33] Although some of the modifications discussed above have eliminated or significantly reduced the incidence of pancreatic fistula, a pancreatic leak remains a major cause of morbidity and mortality after pancreaticoduodenectomy, with incidences reported between 6% and 24% and a mortality rate as high as 40%. 34 Because of these variations in the results of PJ, surgeons have continued to explore other options.…”

Section: Pancreaticojejunostomymentioning

confidence: 99%

Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?

et al. 2005

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Pancreatic anastomotic leak is the single most important factor responsible for the considerable morbidity and mortality associated with pancreaticoduodenectomy. Management of the pancreatic remnant is controversially discussed, reflecting the complexity of anastomosing a pancreas of different textures to the digestive tract. A number of studies evaluating diverse options have often provided conflicting conclusions. This information is confusing particularly to those surgeons outside of large-volume centers with broad experience and to general surgeons who perform pancreatic surgery. A PubMed search with the key words pancreaticoduodenectomy, pancreatic anastomosis, pancreaticojejunostomy, pancreaticogastrostomy, and pancreatic fistula was performed. Major series of pancreatic anastomosis published between 1990 and 2002 were studied from diverse centers worldwide. Their results with regard to pancreatic fistula, morbidity, and mortality were documented. Nine series of pancreaticojejunostomy and seven series of pancreaticogastrostomy were evaluated. Eight comparative studies evaluating the two techniques were also analyzed. A single randomized controlled trial was identified among these comparative studies. Equally good results were observed with the two techniques. Other uncommon methods of management of the pancreatic remnant (duct occlusion and ligation) were also evaluated. Pancreaticojejunostomy followed by pancreaticogastrostomy are the most favored techniques. A duct-to-mucosa anastomosis is preferred over other methods. Fistula rates of less than 5%-10% should be the standard irrespective of the technique used. Unlike in the past, mortality can be reduced even in the event of an anastomotic dehiscence, and this aspect is primarily dependent on a meticulous anastomosis based on sound surgical principles rather than the method per se. Based on the information accumulated, adherence to these specific principles could ensure a safe and reliable pancreatic anastomosis with mimimal morbidity and mortality after pancreaticoduodenectomy, even in the hands of general surgeons operating outside high-volume centers.

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“…Active exocrine secretion of the pancreas is thought to be a major factor responsible for inducing the pancreatic stump‐related complications, and its inhibition would obviously reduce the incidence and severity of complications after pancreatic resection [10, 11, 12, 13, 14, 15]. A variety of reported surgical methods had been used in the management of remnant pancreas and duct to decrease the adverse results of exocrine secretion, including diversion of the pancreatic juice [11, 16] and occlusion of the pancreatic duct [17].…”

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confidence: 99%

Role of Somatostatin in the Prevention of Pancreatic Stump‐related Morbidity following Elective Pancreaticoduodenectomy in High‐risk Patients and Elimination of Surgeon‐related Factors: Prospective, Randomized, Controlled Trial

Shan

Lin

2003

World j. surg.

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A prospective, randomized, controlled trial was performed to determine the efficacy of somatostatin in the prevention of pancreatic stump-related complications with elimination of surgeon-related factors in high-risk patients undergoing pancreaticoduodenectomy. From August 1997 to December 2000, 54 patients, 28 men and 26 women, with age ranged from 32 to 89 years, were randomly assigned to somatostatin group ( n = 27) or placebo group ( n = 27). Ninety-four percent of the patients had pancreatic and periampullary lesions; 6% had secondary lesion involving the duodenum such as local recurrent colon carcinoma and renal cell carcinoma. These patients received either standard pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy. An experienced surgeon performed all operations in same fashion to minimize the surgical factor. A transanastomotic tube was inserted into the pancreatic duct for diversion of pancreatic juice in the pancreaticojejunostomy for a 3-weeks period postoperatively. Intravenous infusion of somatostatin was given at a dose of 250 microg/hr in the somastotatin group and normal saline was given to the control group for 7 days postoperatively. There was one perioperative death in each group, resulting in a 3.7% mortality rate. In the somastotatin group, as compared to the placebo group, the incidence of overall morbidity and pancreatic stump related complications were significantly lower with a mean decrease of 50% pancreatic juice output and a slightly shorter duration of hospital stays. In conclusion, after excluding surgeon related factor, prophylactic use of somatostatin reduces the incidence and severity of pancreatic stump related complications in high-risk patients having pancreaticoduodenectomy via decreased secretion of pancreatic exocrine.

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A Simple, Secure and Universal Pancreaticojejunostomy following Pancreaticoduodenectomy

Cited by 14 publications

References 11 publications

Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy

Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy

Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?

Role of Somatostatin in the Prevention of Pancreatic Stump‐related Morbidity following Elective Pancreaticoduodenectomy in High‐risk Patients and Elimination of Surgeon‐related Factors: Prospective, Randomized, Controlled Trial

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