Anatomy‐Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection

Tajima, Yoshitsugu; Kuroki, Tamotsu; Tsuneoka, Noritsugu; Adachi, Tomohiko; Kosaka, Taiichiro; Okamoto, Tatsuya; Takatsuki, Mitsuhisa; Eguchi, Susumu; Kanematsu, Takashi

doi:10.1007/s00268-009-0179-z

Cited by 13 publications

(12 citation statements)

References 53 publications

(72 reference statements)

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“…However, there are no data available in the literature in support of the abovementioned results. Tajima et al [14] differ from our observations for superiorly placed duct and pancreatic thickness but concur with us that width of pancreatic parenchyma, relationship of PD to inferior margin and anterior margin are insignificant.…”

Section: Discussionsupporting

confidence: 68%

“…A small pancreatic duct diameter or non-dilated pancreatic duct can make the duct-to-mucosa anastomosis difficult or even impossible at times. Hamanaka et al [12] used pancreatic duct diameter less than 3 mm (v/s > 3 mm) as a cut-off limit for risk factor for post-operative pancreatic fistula which is supported by many studies [13][14][15]. Univariate and multivariate analysis by de Castro [10] showed a strong association between the diameter of the main pancreatic duct (< 3 mm) and POPF (P < 0.001 and P < 0.002, respectively).…”

Section: Discussionmentioning

confidence: 94%

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Does the Anatomy of the Transected Pancreatic Neck Influence Post Whipple’s Operation Pancreatic Fistula?

Nikhil

Halder

Santhosh

et al. 2018

Indian J Surg Oncol

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Few studies correlate anatomical parameters of the transected pancreatic neck to occurrence of the dangerous complication-post Whipple's pancreaticoduodenectomy pancreatic fistula. To evaluate the correlation between anatomical details of the transected neck of the pancreas and post-operative pancreatic fistula (POPF) following Whipple's pancreaticoduodenectomy. Observational study. The study included 66 patients undergoing Whipple's pancreaticoduodenectomy with pancreaticojejunostomy at tertiary care centre between December 2009 and December 2014. Student's t test, Fisher's exact test, Pearson's chi-squared test and forward stepwise. Clinically relevant POPF (grade B and C) was noted in 12 patients. Morbidity/mortality was 30.30% and 4.54% respectively. Among the fistula v/s no fistula groups, (a) mean thickness of the pancreatic stump was 12.17 ± 1.40 mm v/s 14.94 ± 1.87 mm (P = 0.000), (b) mean width of the pancreatic stump was 24.33 ± 4.14 mm v/s 25.87 ± 4.02 mm (P = 0.238) and (c) mean pancreatic duct (PD) diameter was 2.92 ± 0.79 mm v/s 4.27 ± 1.39 mm (P = 0.001). Mean distances of PD from anterior, posterior, superior and inferior pancreatic borders in the fistula group v/s no fistula group were 6.08 ± 1.62 mm, 3.17 ± 0.72 mm, 9.92 ± 2.15 mm, and 11.42 ± 3.45 mm v/s 5.93 ± 1.71 mm, 4.83 ± 1.26 mm, 11.83 ± 2.79 mm and 9.96 ± 3.25 mm respectively. Eleven of 38 patients (28.9%) with soft pancreas developed POPF. Pancreatic duct < 3 mm diameter, < 3 mm from posterior border, < 12 mm from superior border, pancreatic neck thickness < 12 mm and soft pancreas consistency were significantly associated with POPF.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 94%

Does the Anatomy of the Transected Pancreatic Neck Influence Post Whipple’s Operation Pancreatic Fistula?

Nikhil

Halder

Santhosh

et al. 2018

Indian J Surg Oncol

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“…Auch die Technik der Anastomose als Duct-to-Mukosa-Technik oder mit Invagination sowie die Naht in Einzelknopf-sowie fortlaufender Technik werden immer noch kritisch diskutiert. Insgesamt zeigt sich ein Trend zur Duct-to-Mukosa-Technik, die der Invagination über-legen scheint [12,15,24,37,38]. Die Studien zeigen signifikant niedrigere PF-Raten.…”

Section: Intraabdominelle Abszesseunclassified

“…Lediglich Berger et al konnten Vorteile der Invagination gegenüber der Duct-to-Mukosa-Anastomose herausstellen [39]. Tajima et al zeigten einen Vorteil der Anastomose mit Einzelknopfnähten gegenüber der fortlaufenden Naht [24]. Insgesamt scheint hinsichtlich der Anastomose die Erfahrung des operierenden Chirurgen unabhängig von der Art der Anastomose wichtiger für die gute Anastomosenheilung zu sein als die Technik selbst [36,40].…”

Section: Intraabdominelle Abszesseunclassified

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Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie

Sülberg¹,

Chromik²,

Köster³

et al. 2010

Zentralbl Chir

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During the last decades mortality after pancreatic surgery has decreased. Nevertheless, morbidity still remains at a high level. It is important to differentiate between pancreatic head resection and distal pancreatectomy. The complication rates of both procedures are high, however the need for intervention to manage perilous complications is higher after pancreaticoduodenectomy. The main complications after pancreatic surgery are delayed gastric emptying (DGE), pancreatic fistula, anastomotic leakage and bleeding. The current literature on the different techniques of pancreatic anastomosis and pancreatic remnant closure, respectively, does not show consistent results or an advantage for a particular technique. The same is true for the perioperative use of somatostatin and its analogues for the prevention of complications. It is widely agreed that the smooth texture of the pancreas and a small pancreatic duct < 3 mm are risk factors for pancreatic leakage or fistula. Today, the trend is more for conservative or interventional therapy for pancreatic fistulas or intraabdominal collections with, e. g., persisting intraoperative drain, TPN, somatostatin therapy or CT-controlled drainage. The opinions about the optimal treatment of the dreaded postoperative bleeding differ significantly in the surgical community. There are early and late bleedings and the management varies from endoscopical treatment or angiographic coiling / stenting to revision. Nevertheless, every bleeding is accompanied with high mortality. Here we present a review of literature and demonstrate the various strategies for the management of complications.

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Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)

et al. 2013

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Anatomy‐Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection

Abstract: Pancreatic anastomosis modified according to the pancreatic anatomy is effective in reducing the risk of pancreatic fistula formation with end-to-side, duct-to-mucosa pancreaticojejunostomy after pancreatic head resection.

Cited by 13 publications

References 53 publications

Does the Anatomy of the Transected Pancreatic Neck Influence Post Whipple’s Operation Pancreatic Fistula?

Does the Anatomy of the Transected Pancreatic Neck Influence Post Whipple’s Operation Pancreatic Fistula?

Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie

Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)

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