Long-term Anastomotic Complications After Pancreaticoduodenectomy for Benign Diseases

Reid‐Lombardo, Kaye M.; Medina, Antonio Ramos-De la; Thomsen, Kristine M.; Harmsen, William S.; Farnell, Michael B.

doi:10.1007/s11605-007-0369-7

Cited by 132 publications

(101 citation statements)

References 23 publications

(21 reference statements)

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“…There is evidence that preoperative biliary drainage increases the incidence of septic complications. 7,13 Endoscopic biliary stenting (as opposed to percutaneous biliary drainage) has also been reported to be protective. 3 Younger patients with injury and benign disease usually have non-dilated bile ducts and are less likely to have received preoperative biliary drainage than those undergoing surgery for malignancy (53% versus 67%).…”

Section: Discussionmentioning

confidence: 99%

Complications of biliary-enteric anastomoses

Khorsandi

et al. 2017

annals

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INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliaryenteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.

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Section: Discussionmentioning

confidence: 99%

Complications of biliary-enteric anastomoses

Khorsandi

et al. 2017

annals

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“…Though low mortality at high-volume medical centers has been achieved (Ho and Heslin, 2003), PDs are still associated with high postoperative morbidity and exo-and endocrine dysfunction (Ghaneh and Neoptolemos, 1999;Grobmyer et al, 2007;Tran et al, 2009). Long-term biliary and pancreatic anastomotic complications following PDs have also been noted (Reid-Lombardo et al, 2007). The amount of resected pancreatic parenchyma largely affects postoperative quality of life of the patients, especially for young patients with a long life expectancy.…”

Section: Introductionmentioning

confidence: 99%

Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections

Cai

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The aim of this study was to evaluate the safety and efficiency of enucleation (EU) for proximal pancreatic non-invasive neoplasms. Methods: Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included. Different operations and outcomes were analyzed. Results: A total of 123 patients were enrolled. Forty patients (32.5%) underwent EU including 18 patients who had tumors close to the main pancreatic duct (MPD). Sixty-one patients (49.6%) had pancreaticoduodenectomy (PD) performed and 22 (17.9%) underwent central pancreatectomy (CP). Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors. Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group. PD was associated with the greatest complication rate (55.7%), followed by EU (50%) and CP (40.9%), though the pancreatic fistula rate after EU was the highest (50%), especially in patients with tumors larger than 3 cm and tumors close to the MPD. EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function. Conclusions: EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.

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“…Besides pancreatic parenchyma, the integrated upper digestive and biliary anatomy also plays a key role in maintaining consequent digestive, immunological and coagulative function and neurohormonal regulation of insulin activity [15] . In addition, ReidLombardo et al [16] have reported that the 5 and 10year cumulative probability of biliary stricture after PD for benign lesions was 8% and 13%; that is why, in recent years, CR, such as central pancreatectomy and enucleation, has been investigated with great interest. In the present study, with a mean of 42.7 mo followup, there was no newonset diabetes mellitus and pancreatic exocrine insufficiency, which is the same as previously reported [1723] .…”

Section: Discussionmentioning

confidence: 99%