The Effect of Prophylactic Transpapillary Pancreatic Stent Insertion on Clinically Significant Leak Rate Following Distal Pancreatectomy

Frozanpor, Farshad; Lundell, Lars; Segersvärd, Ralf; Arnelo, Urban

doi:10.1097/sla.0b013e318251610f

Cited by 86 publications

(56 citation statements)

References 27 publications

(23 reference statements)

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“…Hashimoto et al [13] reviewed 223 consecutive cases of DP and reported that preoperative endoscopic intervention at Wirsung's duct, including endoscopic stent placement, significantly reduced the risk of POPF. However, a prospective RCT in a single institution in Sweden failed to show a prophylactic effect of pancreatic stent insertion against POPF [82]. In this RCT, clinically significant POPF and intra-abdominal abscess were more frequent in patients with stents than in patients without stents; however, this difference was not statistically significant.…”

Section: Pancreatic Stentingmentioning

confidence: 55%

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

et al. 2016

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Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreatoenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP.

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Section: Pancreatic Stentingmentioning

confidence: 55%

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

et al. 2016

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“…Several operative procedures for these tumors have been developed over the past 20 years, including the use of spleen preservation (1) and laparoscopic surgery (2). However, the incidence of the most common and most serious postoperative complication after DP, postoperative pancreatic fistula (PF), was not found to be improved in several clinical prospective trials (3)(4)(5). It is apparent that a radical change in postoperative management is necessary to prevent PF after DP.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of early drain removal and triple-drug therapy to prevent pancreatic fistula after distal pancreatectomy

et al. 2015

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Objective: Prior studies suggested that early drain removal prevented the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD), but there has been no corresponding prospective trial for distal pancreatectomy (DP). The purpose of this study was to determine the safety and efficacy of early drain removal and triple-drug therapy (TDT) with gabexate mesilate, octreotide and carbapenem antibiotics to prevent PF after DP in patients at high-risk of developing PF. Methods:A total 71 patients who underwent a DP were enrolled. We prospectively divided them into two groups: the late-removal group, in which the drain remained in place for at least for 5 days postoperatively (n=30) and the early-removal group in which the drain was removed on postoperative day1 (POD1) (n=41). For the patients with a high drain amylase level (≥ 10,000 IU/L) and patients with symptomatic intraperitoneal fluid collection, our original TDT was introduced. The primary endpoint was the safety and efficacy of this management, and the secondary endpoint was the incidence of PF. Results:The incidence of clinical PF was significantly lower in the early-removal group (0% vs. the late removal 16%; p<0.001). In the early-removal group, TDT was administered to 12 patients (29%) and none of the patients needed additional treatment after TDT. Conclusions:Postoperative management after DP with early drain removal and TDT was safe and effective for preventing PF.

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“…That trial failed to show a benefit of preoperative stenting of the pancreatic duct and in fact demonstrated a trend toward a significantly increased rate of pancreatic fistula among patients with preoperative stent placement [16]. An example that highlights the significant difficulty in obtaining robust best practice standards in this area comes from a similar controversy in pancreaticoduodenectomy.…”

Section: Role Of Pancreatic Stentingmentioning

confidence: 95%

Preventing Pancreatic Fistula Following Distal Pancreatectomy

Nath

Callery

2015

Gastrointestinal Surgery

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The Effect of Prophylactic Transpapillary Pancreatic Stent Insertion on Clinically Significant Leak Rate Following Distal Pancreatectomy

Abstract: The results from this trial show that prophylactic pancreatic stenting does not reduce PF when performing a standardized resection of the body and tail of the pancreas. The trial was registered at clinicaltrials.gov NCT00500968.

Cited by 86 publications

References 27 publications

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

Safety and efficacy of early drain removal and triple-drug therapy to prevent pancreatic fistula after distal pancreatectomy

Preventing Pancreatic Fistula Following Distal Pancreatectomy

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