A New Guideline to Reduce Postoperative Morbidity After Pancreaticoduodenectomy

Abstract

The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been reduced because of the introduction of a new guideline.

Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy

“…Randomization was performed using the permuted‐blocks method within each of two strata defined by the diameter of the main pancreatic duct: dilated (larger than 3 mm) and non‐dilated (3 mm or less). Based on previous reports15, 16, a non‐dilated pancreatic duct was considered to represent an important risk factor for POPF. After removal of the PD specimen, patients were randomized using the sealed envelope method into a stented group with an external drainage stent placed into the pancreatic duct across the PJ, and a non‐stented group with no stent in the PJ.…”

“…A recent RCT comparing PJ with invagination versus a duct‐to‐mucosa anastomosis, stratified by pancreatic texture, showed that soft texture was an independent risk factor for POPF14. A non‐dilated duct is probably an important risk factor for POPF15, 16. Soft parenchyma and a non‐dilated pancreatic duct, which are thought to be closely linked, represent important risk factors for POPF, and should be stratified in RCTs evaluating POPF.…”

Our Contrivances to Diminish Complications After Pylorus-Preserving Pancreaticoduodenectomy

“…Taken together, internal drainage seems to have certain advantages. As for using omental wrapping, Satoi et al 15 reported that the occurrence of pancreatic fistulas in the patients who underwent pancreaticojejunostomies with Kakita's method and omental wrapping was significantly lower (6%) than that in the group who underwent pancreaticojejunostomies with the dunking method (19%). As our patients who underwent the novel reconstruction experienced no pancreatic fistulas, our data seem to confirm the usefulness of the omental wrapping.…”

“…This step differs from that employed in the previously reported technique, in which the omentum had been placed in front of the splanchnic vessels. 11,15…”

“…11,12 The likelihood of a pancreatic fistula can also be reduced, by a duct-to-mucosa pancreaticojejunostomy 3,13,14 and by the use of omental wrapping. 15 However, none of the studies have examined whether the complications after PPPD would be diminished if vertical reconstruction, antecolic reconstruction, internal drainage, and omental wrapping were simultaneously performed.…”