A Novel Technique for the Management of Pancreaticojejunal Anastomosis Dehiscence following Pancreaticoduodenectomy

Bu, Xianmin; Xu, Jin; Dai, Xian-Wei

doi:10.1159/000279811

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…Postoperatively, these drains were removed gradually after evaluation of amylase levels and infection in abdominal fluids. In patients with severe PF, abdominal drains were also used for irrigation around the pancreatic stump, as reported previously [33,34]. Prevalence of complications classified as C-D grade IIIa or higher was 16 % with zero mortality at 90 days in the present series, suggesting that routine placement of drains could ensure the safety of DP.…”

Section: Discussionsupporting

confidence: 71%

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

et al. 2016

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Section: Discussionsupporting

confidence: 71%

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

et al. 2016

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“…From the initially identified 2900 studies, 9 studies provided data regarding continuous irrigation after pancreatectomy and met the inclusion criteria for the systematic review [ 26 – 34 ]. Table 1 shows the descriptive characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies were retrospective, while 3 were case reports. In 3 studies, continuous irrigation was applied prophylactically to prevent the onset of POPF and related complications [ 26 – 28 ], whereas in the other 6 studies was used to manage a clinically relevant POPF and subsequent, already established fluid collections [ 29 – 34 ]. Of note, 3 articles reporting data regarding the prophylactic use of continuous local lavage after pancreatic surgery could not be retrieved and were excluded from the analysis [ 35 – 37 ]; the journal Hepatogastroenterology, in which all 3 articles were published between 2008 and 2010 was discontinued in 2015, and the papers are no longer available.…”

Section: Resultsmentioning

confidence: 99%

Continuous irrigation after pancreatectomy: a systematic review

Pergolini,

Scheufele,

Demir

et al. 2023

Langenbecks Arch Surg

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Purpose Prevention and management of postoperative pancreatic fistula (POPF) after pancreatic resections is still an unresolved issue. Continuous irrigation of the peripancreatic area is frequently used to treat necrotizing pancreatitis, but its use after elective pancreatic surgery is not well-known. With this systematic review, we sought to evaluate the current knowledge and expertise regarding the use of continuous irrigation in the surgical area to prevent or treat POPF after elective pancreatic resections. Methods A systematic search of the literature was conducted according to the PRISMA 2020 guidelines, screening the databases of Pubmed, Scopus, Web of Science, and Ovid MEDLINE. Because of the heterogeneity of the included articles, a statistical inference could not be performed and the literature was reviewed only descriptively. The study was pre-registered online (OSF Registry). Results Nine studies were included. Three studies provided data regarding the prophylactic use of continuous irrigation after distal and limited pancreatectomies. Here, patients after irrigation showed a lower rate of clinically relevant POPF, related complications, lengths of stay, and mortality. Six other papers reported the use of local lavage to treat clinically relevant POPF and subsequent fluid collections, with successful outcomes. Conclusion In the current literature, only a few publications are focused on the use of continuous irrigation after pancreatic resection to prevent or manage POPF. The included studies showed promising results, and this technique may be useful in patients at high risk of POPF. Further investigations and randomized trials are needed.

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“…Thus, the previous PJ anastomosis site could be easily accessed using this method in all our patients, and importantly, neither postoperative intraabdominal abscess formation nor extensive inflammation was observed despite new PF formation occurring in all patients. Second, the adjacent major vessels and organs remain covered and protected by chronic connective scar tissues, a finding in contrast to that observed in the acute phase after PD [ 25 , 26 ]. These connective tissues reduce the risk of critical injury to the adjacent vessels and organs during intraabdominal dissection.…”

Section: Discussionmentioning

confidence: 99%

Redo pancreaticojejunal anastomosis for late-onset complete pancreaticocutaneous fistula after pancreaticojejunostomy

et al. 2022

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Background Pancreaticojejunal (PJ) anastomosis occasionally fails several months after pancreaticoduodenectomy (PD) with Child reconstruction and can ultimately result in a late-onset complete pancreaticocutaneous fistula (Lc-PF). Since the remnant pancreas is an isolated segment, surgical intervention is necessary to create internal drainage for the pancreatic juice; however, surgery at the previous PJ anastomosis site is technically challenging even for experienced surgeons. Here we describe a simple surgical procedure for Lc-PF, termed redo PJ anastomosis, which was developed at our facility. Methods Between January 2008 and December 2020, six consecutive patients with Lc-PF after PD underwent a redo PJ anastomosis, and the short- and long-term clinical outcomes have been evaluated. The abdominal cavity is carefully dissected through a 10-cm midline skin incision, and the PJ anastomosis site is identified using a percutaneous drain through the fistula tract as a guide, along with the main pancreatic duct (MPD) stump on the pancreatic stump. Next, the pancreatic stump is deliberately immobilized from the dorsal plane to prevent injury to the underlying major vessels. After fixing a stent tube to both the MPD and the Roux-limb using two-sided purse-string sutures, the redo PJ anastomosis is completed using single-layer interrupted sutures. Full-thickness pancreatic sutures are deliberately avoided by passing the needle through only two-thirds of the anterior side of the pancreatic stump. Results The redo PJ anastomosis was performed without any intraoperative complications in all cases. The median intraoperative bleeding and operative time were 71 (range 10–137) mL and 123 (range 56–175) min, respectively. Even though a new mild pancreatic fistula developed postoperatively in all cases, it could be conservatively treated within 3 weeks, and no other postoperative complications were recorded. During the median follow-up period of 92 (range 12–112) months, no complications at the redo PJ anastomosis site were observed. Conclusions This research shows that the redo PJ anastomosis for Lc-PF we developed is a safe, feasible, and technically no demanding procedure with acceptable short- and long-term clinical outcomes. This procedure has the potential to become the preferred treatment strategy for Lc-PF after PD.

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A Novel Technique for the Management of Pancreaticojejunal Anastomosis Dehiscence following Pancreaticoduodenectomy

Cited by 7 publications

References 30 publications

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

Continuous irrigation after pancreatectomy: a systematic review

Redo pancreaticojejunal anastomosis for late-onset complete pancreaticocutaneous fistula after pancreaticojejunostomy

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