External Drainage of Pancreatic Duct With a Stent to Reduce Leakage Rate of Pancreaticojejunostomy After Pancreaticoduodenectomy

Poon, Ronnie T. P.; Fan, Sheung Tat; Lo, Chung Mau; Ng, Kelvin K.; Yuen, WK; Yeung, Chun; Wong, John

doi:10.1097/sla.0b013e3181492c28

Cited by 358 publications

(279 citation statements)

References 40 publications

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“…All four trials reported on the incidence of POPF formation following PD with versus without external pancreatic duct stent placement [6][7]9,14]. There was a statistically significant difference in the overall incidence of any grade POPF formation among these cohorts (OR 0.37, 95% CI=0.23 to 0.58, P=0.0001) as well as a statistically significant difference in the incidence of clinically significant (grade B or C) POPF (OR 0.50, 95% CI=0.30 to 0.84, P=0.0009) favoring external stent placement (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Subsequent screening resulted in four prospective randomized trials examining only external pancreatic stents following PD [6][7]9,14]. Of note, the present study excluded two trials previously included by Markar et al [10]; 1) the 2009 prospective trial conducted by Smyrniotis et al [5] on the basis that this study examined internal stents only, and 2) the 2006 trial conducted by Winter et al [4] on the basis that internal stents were included and because these authors utilized an alternating method of allocating patients to either treatment or control arms, which may have inadvertently introduced selection bias as described by Doll [15].…”

Section: Resultsmentioning

confidence: 99%

“…This is then closed with a purse-string suture, externalized via a stab incision in the anterior abdominal wall, and closed by suturing the serosa of the jejunum to the peritoneum of the abdominal wall. In both cases migration of the catheter is prevented with an absorbable suture attachment to the jejunal mucosal surface [4][5][6][7][8][9]. The final PJ reconstruction is then carried out with an end-to-side, duct-to-mucosa anastomosis using 1-or 2-layer interrupted fine sutures [6].…”

Section: Introductionmentioning

confidence: 99%

“…In both cases migration of the catheter is prevented with an absorbable suture attachment to the jejunal mucosal surface [4][5][6][7][8][9]. The final PJ reconstruction is then carried out with an end-to-side, duct-to-mucosa anastomosis using 1-or 2-layer interrupted fine sutures [6].Previous meta analysis performed by Markar et al [10] examined the combined effect of placement of either stent type on clinical outcome following PJ. Based on the integrated data sets, these authors identified a non-statistically significant trend towards reduced pancreatic fistula with the use of either stent method but the data was unable to definitively rule out the null hypothesis that stenting had no beneficial effect.…”

mentioning

confidence: 99%

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A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

Prashant¹,

Thoens²,

Mauricio³

et al. 2014

Pancreat Disord Ther

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IntroductionThe National Cancer Institute has estimated that there will be as many as 45,220 new cases of pancreatic cancer in the U.S. in 2012 and that as many as 38,460 patients will die of the disease this year alone [1]. Pancreaticoduodenectomy (PD) remains the sole potentially curative intervention for several types of peri-ampullary and pancreatic carcinomas and pathologies. Postoperative Pancreatic Fistula Formation (POPF) as a result of pancreaticojejunostomy (PJ) anastomotic failure remains one of the most serious and dreaded complications following PD. POPF is believed to be a consequence of pancreatic exocrine secretion seepage across a compromised anastomotic site, with the most likely mechanism being autodigestion and destruction of the tissue surrounding the PJ anastomotic site leading to dehiscence and seepage into the abdominal cavity. The release of these activated pancreatic juices then cause peripancreatic collections, intra-abdominal abscesses, hemorrhage, and POPF [2].Protection of this anastomotic site has therefore been the focus of many modifications to the original Whipple procedure. Stent placement across the PJ anastomsis has been proposed to protect the integrity of the site by diverting the potentially caustic exocrine secretions of the pancreatic remnant away from the delicate anastomotic site. In addition, such stents have been theorized to promote precise placement of anastomotic sutures, facilitate decompression of the pancreatic remnant, and maintain patency of the pancreatic duct postoperatively [3,4].Two similar though uniquely different procedures have been integrated into the traditional PD procedure with varying reports of actual efficacy; an internal and an external pancreatic duct stent. The internal stent technique is generally performed by inserting a 6 cm stent into the pancreatic duct such that one-half of its length remains within the duct itself, bridges across the anastomotic site, and empties into the jejunal lumen. In contrast, the external stent utilizes a longer stent placed similarly within the pancreatic duct stump, bridges across the anastomotic site into the jenual lumen, but the tail of which is exited through a small enterotomy site in the free end of the jejunal loop. This is then closed with a purse-string suture, externalized via a stab incision in the anterior abdominal wall, and closed by suturing the serosa of the jejunum to the peritoneum of the abdominal wall. In both cases migration of the catheter is prevented with an absorbable suture attachment to the jejunal mucosal surface [4][5][6][7][8][9]. The final PJ reconstruction is then carried out with an end-to-side, duct-to-mucosa anastomosis using 1-or 2-layer interrupted fine sutures [6].Previous meta analysis performed by Markar et al. [10] examined the combined effect of placement of either stent type on clinical outcome following PJ. Based on the integrated data sets, these authors identified a non-statistically significant trend towards reduced pancreatic fistula with the use of either sten...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

Prashant¹,

Thoens²,

Mauricio³

et al. 2014

Pancreat Disord Ther

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“…Pancreatic stenting through pancreatic anastomosis after PDT has long been reported by many authors (1,24,29,42) . Some reasons supporting the usefulness of an internal stent are diverting the pancreatic enzymes from the pancreatic anastomotic area and to allow more precise placement of sutures during pancreatic anastomosis.…”

Section: Pancreatic Fistulamentioning

confidence: 99%

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Fontes

Waechter

Nectoux

et al. 2014

Arq. Gastroenterol.

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-Context -Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the "Achilles' heel" of the procedure.Objective -To evaluate the post-operative 30 days morbidity and mortality rates. Methods -Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate).Results -Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusion -The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients. HEADINGS -Pancreatic neoplasms. Pancreaticoduodenectomy. Mortality.

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Clinically Significant Pancreatic Fistulas

Fujita¹

2008

Arch Surg

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External Drainage of Pancreatic Duct With a Stent to Reduce Leakage Rate of Pancreaticojejunostomy After Pancreaticoduodenectomy

Abstract: External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy.

Cited by 358 publications

References 40 publications

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Clinically Significant Pancreatic Fistulas

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