Radical Pancreaticoduodenectomy

Child, Charles G.; Ellis, John Tracy

doi:10.1097/00000658-195107000-00009

Cited by 10 publications

(4 citation statements)

References 4 publications

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“…PD has long been the standard technique for treatment of any lesions at the pancreatic head[1,2,29]. The first two-stage excision procedure was not accomplished until 1909, and Whipple and Child finally evolved it into a regular operation in 1940 and 1944[3,4]. The mortality rate associated with PD in the mid-19 th century was extremely high, leading to a strict evaluation of surgeons’ qualifications[30-33].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreaticoduodenectomy (PD), mostly known as the Whipple procedure, has been the standard technique for treating a wide variety of lesions at the pancreatic head for many years[1-4]. With the development of surgical techniques, improvements in surgical equipment, and progress in perioperative management, the mortality rate of PD has been reduced to <3% in high-volume academic medical centers[5-8].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Zhang

Cheng

et al. 2019

WJG

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BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and long-term follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques. RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031; and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Zhang

Cheng

et al. 2019

WJG

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“…Although there are several reconstruction techniques, each involves a different pancreatic anastomosis. It is possible to perform a pancreatojejunostomy (PJA) on a single loop, as described by Child in 1944, a PJA on Roux-en-Y, described by Machado, or a pancreatogastrostomy (PGA) [ 4 , 5 , 6 , 7 , 8 , 9 ]. In both the PJA and PGA techniques, some surgeons perform a duct-to-mucosa anastomosis (Wirsung-pancreatojejunostomy or Wirsung-pancreatogastrostomy) and/or use a ductal stent (external or internal stenting) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] There is still no consensus as to the best reconstruction technique for the management of the pancreatic stump.…”

Section: Introductionmentioning

confidence: 99%

Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature

Bizzoca

Fedele

Lippolis

et al. 2021

JCM

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Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which is the best reconstruction method for the treatment of the pancreatic remnant after PD is still a matter of debate. The aim of this study was to retrospectively analyze the morbidity rate in 100 consecutive PD reconstructed with Wirsung-Pancreato-Gastro-Anastomosis (WPGA), performed by a single surgeon applying a personal modification of the pancreatic reconstruction technique. Methods: During an 8-year period (May 2012 to March 2020), 100 consecutive patients underwent PD reconstructed with WPGA. The series included 57 males and 43 females (M/F 1.32), with a mean age of 68 (range 41–86) years. The 90-day morbidity and mortality were retrospectively analyzed. Additionally, a systematic review was conducted, comparing our technique with the existing literature on the topic. Results: We observed eight cases of clinically relevant POPF (8%), three cases of “primary” DGE (3%) and four patients suffering “secondary” DGE. The surgical morbidity and mortality rate were 26% and 6%, respectively. The median hospital stay was 13.6 days. The systematic review of the literature confirmed the originality of our modified technique for Wirsung-Pancreato-Gastro-Anastomosis. Conclusions: Our modified double-layer WPGA is associated with a very low incidence of POPF and DGE. Also, the technique avoids the risk of acute hemorrhage of the pancreatic parenchyma.

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“…Er glaubte zuna Èchst ein distales Magenkarzinom zu operieren. Die dann von Child vero Èffentlichte Version der Operation [6], die eigentlich dem heutigen Versta Èndnis eines ¹klassischen Whipplesª (Whipple) sehr viel na Èher kommt als die Originalrekonstruktion, u Èbernimmt die Antrektomie ohne dafu Èr eine Rationale zu liefern. Obwohl schon 1944 von Watson erstmals beschrieben [32], gelten Traverso und Longmire als die Va Èter der magen-oder pyloruserhaltenden Duodenopankreatektomie (PEDP) [28].…”

unclassified

Die magenerhaltende Duodenopankreatektomie - Indikation und Kontraindikation. Die wichtigsten operativen Schritte -

Röher

Heise²,

Goretzki³

2000

Zentralbl Chir

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Discussion on pylorus-preserving pancreatoduodenectomy (PPPD) in case of ductal adenocarcinoma is controversal. Aim of the present study was the comparison of survival in patients resected by the classic Whipple operation (Whipple) or the pylorus-preserving procedure. From April 1986 to June 1998 all patients operated for proven diagnosis of ductal pancreatic cancer were documented prospectively concerning patient's characteristics, kind of surgery, complications and histopathological staging according to the UICC-classification of 1992. During the observation period 100 patients underwent pancreatoduodenectomy, 38 cases as Whipple, 62 as PPPD. Average of age was 59.9 +/- 10.3 years without significant differences. Mortality was 6.0% in total, 5.5% post Whipple, and 6.5% post PPPD. Eighty-three percent of the resected specimen were node positive. The median survival time was 9.9 and 10.5 months, 5-year survival 2.6% and 10%, respectively without significant differences. Actually, only node positive patients reached 5-year survival. Even better survival figures following PPPD than after classic Whipple procedure make the pylorus-preserving procedure the standard operation in ductal cancer of the pancreatic head. Distal gastric resection is only mandatory in case of tumor involvement of the duodenopancreatic angle. Since only node negative cases survived 5 years, extensive surgery exceeding anatomical pancreatic head resection does not appear to be beneficial.

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Radical Pancreaticoduodenectomy

Cited by 10 publications

References 4 publications

Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature

Die magenerhaltende Duodenopankreatektomie - Indikation und Kontraindikation. Die wichtigsten operativen Schritte -

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