Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy

Hirashita, Teijiro; Ohta, Masayuki; Yada, Kazuhiro; Tada, Kazuhiro; Saga, Kunihiro; Takayama, Hiroomi; Endo, Yuichi; Uchida, Hajime; Iwashita, Yukio; Ito, Masafumi

doi:10.1016/j.amjsurg.2018.03.023

Cited by 24 publications

(31 citation statements)

References 18 publications

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“…Both techniques were formulated to reduce the pancreatic fistula by avoidance of tearing and destruction of the pancreatic capsule and parenchyma during transaction. This finding was further supported by the study of Hirashita et al [43] in 2018. This approach has been widely accepted in recent studies comparing the handsewn and stapled closure of the pancreatic remnant, which yielded no difference between the two approaches in terms of POPF [10,22].…”

Section: Stapled Closure Of Pancreatic Remnantsupporting

confidence: 72%

“…Sufficient drainage is the basis of treatment for POPF. In most cases, peritoneal fluid collection caused by pancreatic fistula could be effectively managed through routine abdominal drainage [6,29], percutaneous peritoneal drainage under CT or ultrasound guidance [29,33,47,73], and internal drainage using endoscopic ultrasonography by placing pancreatic duct stents [17,29]. With sufficient drainage combined with nutritional support [73], antibiotic therapy [74], and inhibition of pancreatic secretion, most patients would recover uneventfully from POPF.…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

“…Surgical treatment should be considered for patients with POPF who fail to respond to conservative treatment. After non-surgical treatment, patients that still have persistent pancreatic fistula, abdominal bleeding, abdominal abscess, sepsis, and other critical situations require further surgical treatment [24,29,39,47,73].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Reoperation approach includes placement of drainage in the vicinity of pancreatic stump or anastomosis site (the pancreatic stump could be further resected and sutured again) [73,74], anastomosis of pancreatic stump and digestive tract, and removing a part of pancreatic tissue or even the whole pancreas. In case of ischemic necrosis of other organs, combined resection of vessels and organs is even required [29].…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

2019

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Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.

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Section: Stapled Closure Of Pancreatic Remnantsupporting

confidence: 72%

Section: Non-surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

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Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

2019

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“…Тяжелым последствием дистальной ре зекции являются панкреатические свищи, частота которых может достигать от 3,5 до 26 % и выше [18,20,22]. Как фактор риска этого осложнения указывается высокий ин декс массы тела, утолщенная «мягкая» железа и массивная кровопотеря [23,27] Еще у 4 (8,5 %) пациентов проведены различ ные симультанные вмешательства. Отмечен и «конфликт оперирующего хирурга» с глав ным лимфатическим протоком (1), с верхней брыжеечной веной (1) и с двенадцатиперст ной кишкой (1).…”

Section: Introductionunclassified

Short-and long-term results of distal pancreatectomy

et al. 2019

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Aim. To assess the results of distal pancreatectomy for malignant and benign tumors and chronic pancreatitis complications. Materials and methods. Forty-seven patients, who underwent distal pancreatectomy, were under observation during the period from 01.01.2008 to 28.02.2019. Results. The long-term results of surgical treatment demonstrated the following complications: pancreatic fistulas – 15 % of observations, pancreatogenic diabetes mellitus – 12.7 %, subphrenic abscesses – 10 %. In the long-term period after the surgery – from 10 years and not less than one year – 30 patients were followed up, constituting 63.8 % of the total number. Conclusions. To prevent complications in the form of pancreatic fistula with pathological Wirsung duct dilatation more than 4–5 mm in diameter, it is necessary to form anastomosis between the pancreatic stump and the small bowel.

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Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula

Adamenko

Ferrari

Schmidt

2020

Langenbecks Arch Surg

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Introduction Postoperative pancreatic fistula (POPF) represents the most common form of morbidity after distal pancreatectomy (DP). The aim of this study was to illustrate an innovative technique of irrigation and passive drainage to reduce clinically relevant POPF (CR-POPF) incidence in high-risk patients undergoing DP. Material and methods Twelve consecutive high-risk patients received irrigation and passive drainage of the pancreatic stump with a Salem sump drainage after DP. The Salem sump was irrigated with 100 ml/h of Ringer solution for 2 postoperative days (POD). In the case of low-drain amylase and lipase levels on POD 3, the irrigation was reduced to 50 ml/h. Persistence of low-drain pancreatic enzymes on POD 4 allowed for interruption of irrigation and subsequent removal of drainage from POD 7 onward in the absence of evidence of any pancreatic fistula. Results Overall, 16.6% of the patients experienced a grade 3 or higher surgical complication. We experienced only one case of POPF: the fistula was classified as grade B and it was managed with radiologic drainage of the fluid collection. We did not experience any case of re-operation nor in-hospital mortality. Conclusions Irrigation with passive drainage of the pancreatic stump after DP is an interesting approach for CR-POPF prevention in high-risk patients.

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Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy

Cited by 24 publications

References 18 publications

Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

Short-and long-term results of distal pancreatectomy

Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula

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