Pancreas transplantation with enteric drainage: duodenal segment leak

Heredia, E.N; Ricart, M. J.; Astudillo, E.; López-Boado, M.Á.; Delgado, Sara Martínez; Amador, A.; Pérez, M.; Esmatjes, Enric; Fernández‐Cruz, Laureano

doi:10.1016/s0041-1345(01)02731-2

Cited by 16 publications

(13 citation statements)

References 7 publications

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“…Currently, bladder drainage and enteric drainage are the two accepted means of draining exocrine secretions. Several transplant centers have reported a leak rate of 9–14% in bladder‐drained grafts and a lower rate, close to 5–8%, in enteric‐drained grafts (1, 4). Those reports primarily focused on leaks that developed early after the transplant; however, our report focuses only on leaks occurring well after the initial post‐transplant period.…”

Section: Discussionmentioning

confidence: 99%

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Nath

Gruessner

Kandaswamy

et al. 2005

Clinical Transplantation

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Section: Discussionmentioning

confidence: 99%

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Nath

Gruessner

Kandaswamy

et al. 2005

Clinical Transplantation

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“…The incidence of surgical complications is also similar by type of transplant (SPK compared to solitary pancreas transplantation) [1][2][3] . Leaks from the allograft duodenum have been reported to occur in 5%-20% of bladder-drained and 5%-8% of bowel-drained pancreas transplants [9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][67][68][69][70][71][72][73]80,[91][92][93][94][95] . Increasing experience with enteric exocrine drainage is likewise associated with a decreased rate of technical complications [9,38,80,[96][97][98][99][100][101][102][103] .…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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“…Late duodenal leaks have been related to duodenal perforation secondary to infectious or ischemic ulcers. Rejection and cytomegalovirus (CMV) infection are the other possible risk factors for duodenal leak [20]. The cause of duodenal leak in our case could be a reperfusion injury or graft pancreatitis as the patient had abdominal signs along with fever and raised inflammatory markers with negative initial cultures.…”

Section: Discussionmentioning

confidence: 82%

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

et al. 2016

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Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.

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Pancreas transplantation with enteric drainage: duodenal segment leak

Cited by 16 publications

References 7 publications

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

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