A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation

Abstract

Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno-jejunostomy; the use of Roux-en-Y enteric drainage is uncommon. We report a retrospective analysis of a single-centre experience of Roux-en-Y enteric drainage following pancreas transplantation. Over a 14-year period (2001-2015), 204 consecutive adult pancreas transplants were performed (96.6% simultaneous pancreas and kidney transplants), of which 26.0% were from donors after circulatory death (DCD). During a median follow-up of 67 months (range 13-183 months), 14 (6.9%) recipients experienced complications related to their enteric drainage. Complications during follow-up included early enteric anastomotic haemorrhage (five patients), non-anastomotic enteric bleeding (one patient), small bowel obstruction (four patients) and graft duodenal perforation (two within 6 weeks, five beyond 12 months). No recipient lost their graft as a direct result of complications related to enteric drainage. Patient and pancreas graft survival at 1 year was 99.0% and 94.0% and at 5 years 91.3% and 84.9%, respectively. We conclude that Roux-en-Y enteric drainage following pancreas transplantation is a safe and effective procedure and facilitates graft salvage in the event of graft duodenal perforation.

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Uremia, and Insulin-Dependent Diabetes

“…Enteric drainage is preferred because it can drain pancreatic secretions into the dysfunctional intestine, thereby transferring the contents of the small intestine from the transplanted duodenal-jejunal anastomosis. However, it can be easier to achieve graft rescue if the duodenum-jejunum anastomosis leaks when perforation occurs [ 22 ].…”

CT fluoroscopy‐guided pancreas transplant biopsies: a retrospective evaluation of predictors of complications and success rates

“…Originally, enteric drainage was described with a Roux‐en‐Y loop [34]. Currently, the majority of PTX are performed without Roux‐en‐Y technique in favor of a direct side‐to‐side anastomosis as performed at our institution [35]. Alternative implantation techniques include duodenal drainage (via duodenoduodenostomy) with retroperitoneal placement of the allograft.…”

Technical factors that minimize the occurrence of early graft failure in pancreas transplantation

“…Amin et al suggested that Roux-en Y enteric drainage is a safe and effective procedure, especially in the event of graft duodenal perforation. 38 Shokouh-Amiri and Zibari suggested gastric drainage which was enable to graft duodenum by endoscopy. 39 However, the intraperitoneal location of the graft pancreas might result in the risk of postoperative adhesions.…”

“…Amin et al. suggested that Roux‐en Y enteric drainage is a safe and effective procedure, especially in the event of graft duodenal perforation 38 …”