Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage

Hamanaka, Yuichiro; Nishihara, Kenji; Hamasaki, Tatsunori; Kawabata, Akihiro; Yamamoto, Shigeru; Tsurumi, Masashi; Ueno, Takayoshi; Suzuki, Takashi

doi:10.1016/s0039-6060(96)80114-0

Cited by 142 publications

(111 citation statements)

References 20 publications

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“…The soft and fatty texture of the pancreas [38][39][40][41][42][43][44][45][46] with a non dilated duct (duct size < 3 mm) [45,46] has a higher incidence of fistula when compared to fibrotic/atrophic pancreas with a dilated duct. Increased secretion of pancreatic juice is seen in patients with soft or normal pancreatic remnant and is associated with increased rates of POPF [41]. In a meta-analysis, Bartoli et al observed that incidence of POPF was influenced by the pathology of the disease and the location of the tumor.…”

Section: Organ and Disease Related Factorsmentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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Section: Organ and Disease Related Factorsmentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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“…The overall rate of pancreatic fistula after pancreaticoduodenectomy ranges from 17% in patients in whom the pancreatic remnant has a hard consistency [12] and exocrine pancreatic function and pancreatic juice output are impaired [13] to 25% in cases in which the pancreas is soft [1], that is, the parenchyma is normal [13]. Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.…”

Section: W175mentioning

confidence: 99%

“…Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.…”

Section: W175mentioning

confidence: 99%

“…

The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15].

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mentioning

confidence: 99%

“…Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region.…”

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confidence: 99%

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Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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W175as "drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than three times the serum amylase activity" [11].The overall rate of pancreatic fistula after pancreaticoduodenectomy ranges from 17% in patients in whom the pancreatic remnant has a hard consistency [12] and exocrine pancreatic function and pancreatic juice output are impaired [13] to 25% in cases in which the pancreas is soft [1], that is, the parenchyma is normal [13]. Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region. Although the mortality rate has decreased to approximately 1-2% at high-volume centers, the morbidity rate ranges from 30% to 50% [1][2][3][4]. The two most frequent complications of pancreaticoduodenectomy are delayed gastric emptying and pancreatic fistula. G a s t r oi nt e s t i n a l I m ag i ng • O r ig i n a l R e s e a rc hPancreatic fistula after pancreaticoduodenectomy is a serious complication resulting in prolonged hospital stay, increased costs, readmission, and a mortality rate of 3-9% [5,6]. Efforts to reduce the incidence of pancreatic fistula have included definition of risk factors [1,7], improvement of surgical technique [8,9], and perioperative administration of somatostatin and its analogues [1,10]. The International Study Group on Pancreatic Fistula has defined pancreatic fistula OBJECTIVE. The purpose of this study was to evaluate the sensitivity and specificity of routine performance of CT on postoperative day 7 in patients at high risk of pancreatic fistula after pancreaticoduodenectomy.MATERIALS AND METHODS. Two radiologists analyzed images from CT examinations of 50 patients with soft pancreas 7 days after pancreaticoduodenectomy. Pancreatic fistula was defined at CT as a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis. Clinicobiologic criteria for the diagnosis of pancreatic fistula were drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content more than three times the serum amylase activity. The final diagnosis of pancreatic fistula was rendered on the basis of clinicobiologic data at hospital discharge or at first readmission.RESULTS. At hospital discharge or at first readmission, 27 of 50 patients (54%) had a pancreatic fistula. On postoperative day 7, 30 patients (60%) had a total of 51 fluid collections, and CT showed a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis in 21 of 51 cases. CT had a sensitivity of 63% (17/27 pat...

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Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

Sato

Yamaguchi²,

Chijiiwa³

et al. 1998

Arch Surg

150

118

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Objective: To evaluate the risk factors for pancreatic fistula after pancreatic head resection.Design: Retrospective review. Patients and Intervention:Sixty-two patients who underwent pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for pancreatic fistula.Main Outcome Measures: Pancreatic fistula was defined as high amylase level (Ͼ1000 U/L) in the drainage fluid collected from the peripancreatic drains and/or anastomotic disruption demonstrated radiographically.Results: Nine (15%) of the 62 patients developed pancreatic fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the pancreatic fistula. A preoperative normal N-benzoyl-L-tyrosyl-p-aminobenzoic acid test result (P=.01), soft or intermediate pancreatic consistency (P=.04), duodenum-preserving pancreatic head resection for the normal exocrine pancreas (P=.002), and a larger amount of postoperative pancreatic juice output (P=.02) were significant risk factors for pancreatic fistula formation.

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Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage

Cited by 142 publications

References 20 publications

Pancreatoduodenectomy - Preventing Complications

Pancreatoduodenectomy - Preventing Complications

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

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