Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures?

Greene, Barry S.; Loubeau, Jean M.; Peoples, James B.; Elliott, Dan W.

doi:10.1016/0002-9610(91)90359-l

Cited by 75 publications

(45 citation statements)

References 12 publications

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“…Particular risk factors for breakdown of the pancreatic anastomosis are a soft parenchymal texture of the pancreatic remnant, the size of the remnant, the degree of pancreatic exocrine function and the anastomotic technique [51]. It is not clear which of the different anastomotic techniques produces optimal results [24, 30, 62, 63, 64, 65]. Di Carlo et al [66]have reported good results by occluding the pancreatic remnant duct with Neoprene ® .…”

Section: Fistulae Of the Pancreatointestinal Anastomosismentioning

confidence: 99%

Complications of Pancreatic Cancer Resection

et al. 2002

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Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18–54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13–18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.

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Section: Fistulae Of the Pancreatointestinal Anastomosismentioning

confidence: 99%

Complications of Pancreatic Cancer Resection

et al. 2002

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“…The mortality risk from a major pancreatic fistula is up to 28% and the cause of death is retroperitoneal sepsis and haemorrhage [20, 22, 28]. Some but not all studies have identified risk factors for pancreatic anastomotic breakdown including a soft parenchyma, a small main pancreatic duct diameter, ampullary carcinoma and anastomotic technique [9, 22, 28]although it is not clear which of the different anastomotic techniques have produced optimal results [29, 30, 31, 32]. …”

Section: External Pancreatic Fistulamentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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“…In prospective/retrospective uncontrolled studies, some groups have reported higher incidences of pancreatic fistulas with the end-to-side compared with the end-to-end anastomosis in pancreatic cancer surgery (15–17 vs. 3–11%, respectively) [46, 47]. Consequently, these groups suggest performing end-to-side anastomoses only in patients with a dilated pancreatic duct and firm pancreatic parenchyma, frequently found in chronic pancreatitis or in obstructive pancreatic cancer.…”

Section: Surgical Complications Following Pancreatic Resectionmentioning

confidence: 99%

Prevention and Treatment of Complications in Pancreatic Cancer Surgery

et al. 1999

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Pancreatic cancer is the fourth leading cause of death from malignant disease in Western industrialized countries. It is a devastating disease with a very poor prognosis and has a death rate roughly equal to its incidence rate. As this tumor is resistant to all medical treatment options, such as radio- and chemotherapy, radical surgical resection is the only chance of cure so far. Significant advances have been made over the past decades in pancreaticoduodenectomy, which is the standard operation in patients with pancreatic head cancer or periampullary cancer. In specialized centers the operative mortality has fallen under 5%. However, the postoperative complication rates after this demanding procedure are still between 30 and 40%. Complications are mainly due to the technical difficulty of performing a safe and proper anastomosis between the stomach or small bowel and the soft pancreas. This article reviews the treatment of the complications most frequently occurring after pancreatic cancer surgery, such as leakage of pancreatic anastomosis, pancreatic fistula, abscess and hemorrhage. Furthermore, we discuss the management of these complications and how complications following pancreatic surgery can be prevented.

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Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures?

Cited by 75 publications

References 12 publications

Complications of Pancreatic Cancer Resection

Complications of Pancreatic Cancer Resection

Surgical Treatment of Pancreatic Fistula

Prevention and Treatment of Complications in Pancreatic Cancer Surgery

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