Internal stenting across the pancreaticojejunostomy and main pancreatic duct after pancreaticoduodenectomy

Singh, Kamaldeep; Kaman, Lileswar; Tandup, Cherring; Raypattanaik, Niladri Mohan; Dahiya, Divya; Behera, Arunanshu

doi:10.5604/01.3001.0014.7225

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…However, PD without pancreatic duct stenting is both safe and reliable and can reduce overall operative time and hospital stay. No significant differences were observed in the incidence of postoperative complications in another study 34 .…”

Section: Pancreatic Duct Stentmentioning

confidence: 75%

Pancreatic Fistula after Pancreatoduodenectomy: Evaluation of Different Surgical Techniques

Ruangsin,

Chaiyakul

2024

PSU Med J

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Postoperative pancreatic fistula (POPF) is one of the most fatal complications of pancreatoduodenectomy. POPF is caused by leakage of pancreatic juice from the pancreatic anastomosis into the abdomen, leading to intra-abdominal complications, such as severe surgical site infections, significant postoperative hemorrhage and multi-organ failure. Many risk factors for POPF have been identified, including patient and surgical technique factors. Our objective was to review the literature on surgical techniques to prevent POPF after pancreatoduodenectomy. Pancreatogastrostomy (PG) has the same incidence of POPF as pancreatojejunostomy (PJ). For PJ anastomosis, the interrupted suture and Blumgart technique also had the same rate of POPF. For soft pancreas it was shown that invagination was better than duct-to-mucosa anastomosis to prevent the POPF. However, a pancreatic duct stent cannot decrease the rate of POPF over the non-stent group. Intraperitoneal drainage cannot prevent POPF, however, it can detect POPF more than the non-drain group. Laparoscopic PD (LPD) and robotic-assisted PD (RAPD) were comparable in rates of POPF with open PD. Overall, no conclusion has been reached regarding the best surgical technique. In any individual case, the surgical technique should be selected based on the surgeon’s experience in reducing the incidence of POPF, and other complications.

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Section: Pancreatic Duct Stentmentioning

confidence: 75%

Pancreatic Fistula after Pancreatoduodenectomy: Evaluation of Different Surgical Techniques

Ruangsin,

Chaiyakul

2024

PSU Med J

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Stent placement for the prevention of clinically-relevant postoperative pancreatic fistula following pancreaticojejunostomy: A systematic review and meta-analysis

Sun,

Li,

Liu

et al. 2024

The American Journal of Surgery

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Treatment strategies to prevent or mitigate the outcome of postpancreatectomy hemorrhage: a review of randomized trials

Montorsi,

Zonderhuis,

Daams

et al. 2023

International Journal of Surgery

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Background: Post-pancreatectomy hemorrhage (PPH) is a leading cause for surgical mortality after pancreatic surgery. Several strategies for the prevention and management of PPH have been studied in randomized controlled trials (RCTs) but a systematic review is lacking. We systematically reviewed RCTs regarding the impact of treatment strategies on the incidence and outcome of PPH. Material and methods: Eligible RCTs reporting on impact of treatment on the rate of PPH were identified through a systematic literature search using the Evidence Map of Pancreatic Surgery (2012-2022). Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for RCTs. Various definitions of PPH were accepted and outcome reported separately for the International Study Group for Pancreatic Surgery (ISGPS) definition. Results: Overall, 99 RCTs fulfilled the eligibility criteria with a pooled 6.1% rate of PPH (range 1%-32%). The pooled rate of PPH defined as ISGPS grade B/C was 8.1% (range 0-24.9%). Five RCTs reported five strategies that significantly reduced the rate of PPH. Three concerned surgical technique: pancreatic anastomosis with small jejunal incision, falciform ligament wrap around the gastroduodenal artery stump, and pancreaticojejunostomy (vs pancreaticogastrostomy). Two concerned perioperative management: perioperative pasireotide administration, and algorithm-based postoperative patient management. No single RCT specifically focused on the treatment of patients with PPH. Conclusion: This systematic review of RCTs identified five strategies which reduce the rate of PPH; three concerning intraoperative surgical technique and two concerning peri-operative patient management. Future studies should focus on the treatment of patients with PPH as RCTs are currently lacking.

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Internal stenting across the pancreaticojejunostomy and main pancreatic duct after pancreaticoduodenectomy

Cited by 5 publications

References 18 publications

Pancreatic Fistula after Pancreatoduodenectomy: Evaluation of Different Surgical Techniques

Pancreatic Fistula after Pancreatoduodenectomy: Evaluation of Different Surgical Techniques

Stent placement for the prevention of clinically-relevant postoperative pancreatic fistula following pancreaticojejunostomy: A systematic review and meta-analysis

Treatment strategies to prevent or mitigate the outcome of postpancreatectomy hemorrhage: a review of randomized trials

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