Comparison of enteric versus bladder drainage in pancreas transplantation

Corry, Robert J.; Chakrabarti, Pradip; Shapiro, Ron; Jordan, Mark L.; Scantlebury, Velma P.; Vivas, Carlos

doi:10.1016/s0041-1345(00)02626-9

Cited by 27 publications

(18 citation statements)

References 3 publications

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“…Currently, bladder drainage and enteric drainage are the two accepted means of draining exocrine secretions. Several transplant centers have reported a leak rate of 9–14% in bladder‐drained grafts and a lower rate, close to 5–8%, in enteric‐drained grafts (1, 4). Those reports primarily focused on leaks that developed early after the transplant; however, our report focuses only on leaks occurring well after the initial post‐transplant period.…”

Section: Discussionmentioning

confidence: 99%

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Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Nath

Gruessner

Kandaswamy

et al. 2005

Clinical Transplantation

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Section: Discussionmentioning

confidence: 99%

“…One feared complication of this procedure is an anastomotic leak from the duodenal anastomosis, with resulting high rates of abdominal infections and graft loss. The rate of pancreatic fistula in a bladder-drained graft is in the range of 9-14%; some evidence indicates that this rate may be lower in recipients with enteric drainage (1).…”

mentioning

confidence: 99%

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Nath

Gruessner

Kandaswamy

et al. 2005

Clinical Transplantation

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“…The incidence of surgical complications is also similar by type of transplant (SPK compared to solitary pancreas transplantation) [1][2][3] . Leaks from the allograft duodenum have been reported to occur in 5%-20% of bladder-drained and 5%-8% of bowel-drained pancreas transplants [9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][67][68][69][70][71][72][73]80,[91][92][93][94][95] . Increasing experience with enteric exocrine drainage is likewise associated with a decreased rate of technical complications [9,38,80,[96][97][98][99][100][101][102][103] .…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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“…The threshold for exploration of the pancreas transplant should therefore be low. Several transplant centres have reported a leak rate of 9–14% in bladder‐drained pancreas transplants and a lower rate, 5–8%, in enteric‐drained pancreas transplants 58,59 . These anastomotic leaks, although less than for bladder‐drained pancreas transplants, are of much greater consequence.…”

Section: Surgical Complicationsmentioning

confidence: 99%

“…Several transplant centres have reported a leak rate of 9-14% in bladder-drained pancreas transplants and a lower rate, 5-8%, in enteric-drained pancreas transplants. 58,59 These anastomotic leaks, although less than for bladder-drained pancreas transplants, are of much greater consequence. For bladder drainage versus enteric drainage in patients with a duodenal anastomotic leaks, the graft loss and mortality rates were 20% versus 55% and 7% versus 18%, respectively.…”

Section: Surgical Complicationsmentioning

confidence: 99%