Safety of Non-stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

Usuba, Teruyuki; Misawa, Takeyuki; Ito, Ryusuke; Yoshida, Kazuhiko; Hanyu, Nobuyoshi; Yanaga, Katsuhiko

doi:10.21873/anticanres.11268

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…After dissection of the bile duct, the stump was clamped to avoid spillage of bile juice. Pancreatic texture was assessed intraoperatively by palpation, as described in a previous study 10) . Pancreaticojejunostomy was performed in all patients using twolayer ducttomucosa anastomosis ; the modified -Kakita method 11) with external drainage of the pancreatic duct by a stent.…”

Section: Technique Of Pancreaticoduodenectomy and Perioperative Managmentioning

confidence: 99%

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Sato

Kimura

Kenjo

et al. 2020

FJMS

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Early intraabdominal infection (IAI) following pancreaticoduodenectomy (PD) is an initial event relating to morbidities caused by postoperative pancreatic fistula (POPF). The aims of this study were to determine factors associated with IAI, and to investigate its impact on postoperative outcome. Consecutive patients, 113 in total, who underwent PD at Fukushima Medical University Hospital between January 2012 and September 2017 were included in this retrospective study. IAI was defined by positive bacterial culture from intraabdominal drainage fluid any time through postoperative day 3 (POD3). Logistic regression analysis was used to identify the relevant factors associated with IAI. The clinical impact of the POD3 infection indicators related to POPF were assessed by multivariate analysis. The incidence of IAI, POPF, and mortality were 36.1%, 36.1%, and 0%, respectively. Independent factors associated with IAI were preoperative biliary drainage (PBD) (OR=2.91, CI=1.16-7.33, p=0.023) and soft pancreas (OR=8.67, CI=2.37-31.77, p=0.001). Among infection markers on POD3, the significant factors for POPF were CRP (OR=1.18, CI=1.08-1.30, p<0.001), IAI (OR=7,37, CI=2.53-21.5, p<0.001), and drain amylase (OR=1.00, CI=1.00-1.01, p=0.001). In conclusion, PBD, soft pancreas, and higher age were associated with IAI. IAI has a significantly negative impact on postoperative outcome.

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Section: Technique Of Pancreaticoduodenectomy and Perioperative Managmentioning

confidence: 99%

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Sato

Kimura

Kenjo

et al. 2020

FJMS

View full text Add to dashboard Cite

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“…For interest, we performed a pooled analysis of individual studies used in the three meta-analyses of contention, with the addition of Kawaii et al's findings. [1][2][3][4][5][6][7][8][9][10][11][12] This did not overturn the overall conclusion as anticipated by the authors (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.56-1.53, p = 0.75) (Figure 1). Importantly, it was not possible to differentiate between Grade B and Grade C postoperative pancreatic fistula (POPF), which was the insight offered by Jiang et al Their meta-analysis reported a significantly lower rate of Grade C POPF with the use of an external versus internal stent (OR 0.58, 95% CI 0.35-0.96).…”

mentioning

confidence: 78%

Response to comment: External drainage of the pancreatic duct in pancreatojejunostomy for preventing postoperative pancreatic fistula: Efficacy and side effects

Lim

Samra

Mittal

2022

Journal of Surgical Oncology

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“…However, recent studies performed worldwide have revealed that the absence of a pancreatic duct stent is safe and reliable and has no effect on the development of pancreatic fistula. [15][16][17] One randomized controlled study showed that the incidence of postoperative pancreatic fistula did not increase and that no statistically significant difference was present when pancreaticojejunostomy without a pancreatic stenting tube was performed compared with a control group. Other complications such as delayed gastric emptying, abdominal infection, bleeding, and perioperative mortality were not significantly different.…”

Section: Discussionmentioning

confidence: 99%

Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy

et al. 2017

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ObjectiveTo evaluate the clinical effect of different pancreaticojejunostomy techniques in the treatment of pancreaticoduodenectomy and investigate the applicability of pancreaticojejunostomy without pancreatic duct stenting.MethodsFrom January 2012 to December 2015, 87 patients who underwent pancreaticoduodenectomy were randomly assigned to either Group A (duct-to-mucosa anastomosis with pancreatic duct stenting, n = 43) or Group B (pancreas–jejunum end-to-side anastomosis without stenting (n = 44). The operative duration of pancreaticojejunostomy, postoperative hospital stay, and incidence of postoperative complications were compared between the two methods.ResultsThe operative duration of pancreaticojejunostomy without use of the pancreatic duct stent was significantly shorter in Group B than in Group A (t = 7.137). The postoperative hospital stay was significantly shorter in Group B than in Group A (t = 2.408). The differences in the incidence of postoperative complications such as pancreatic fistula, abdominal bleeding, abdominal infection and delayed gastric emptying were not significantly different between the two groups (χ2 = 0.181, 0.322, 0.603, and 0.001, respectively).ConclusionPancreaticoduodenectomy without pancreatic duct stenting is safe and reliable and can reduce the operative time and hospital stay. No significant differences were observed in the incidence of postoperative complications.

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Safety of Non-stented Pancreaticojejunostomy in Pancreaticoduodenectomy for Patients with Soft Pancreas

Abstract: Since pancreatic duct stenting in pancreaticojejunal anastomosis for patients with soft pancreas did not reduce pancreatic fistula after pancreaticoduodenectomy, non-stented pancreaticojejunostomy for soft pancreas seems safe.

Cited by 6 publications

References 26 publications

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Response to comment: External drainage of the pancreatic duct in pancreatojejunostomy for preventing postoperative pancreatic fistula: Efficacy and side effects

Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy

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