Reliability of Continuous Suture of Pancreaticojejunostomy after Pancreaticoduodenectomy

Han, Hogyu; Choi, Sae Byeol; Lee, Jin Suk; Kim, Wan Bae; Song, Tae Jin; Suh, Soon Yong; Kim, Young Chul; Choi, Sang Yong

doi:10.5754/hge10314

Cited by 10 publications

(4 citation statements)

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“…Some 23 665 patients had malignant disease and of these 12 097 had pancreatic ductal adenocarcinoma, 3778 distal cholangiocarcinoma, 3189 ampullary carcinoma and 1456 duodenal carcinoma. Study characteristics are summarized in Table S3 14–126 . Ninety‐one studies were retrospective cohort studies, 28 prospective cohort studies and three randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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Background Many studies have explored factors relating to post‐operative pancreatic fistula (POPF); however, the original definition (All‐POPF) was revised to include only ‘clinically relevant’ (CR) POPF. This study identified variables associated with the two International Study Group on Pancreatic Surgery definitions to identify which variables are more strongly associated with CR‐POPF. Methods A systematic review identified all studies reporting risk factors for POPF (using both International Study Group on Pancreatic Fistula definitions) following pancreatoduodenectomy. The primary outcome was factors associated with CR‐POPF. Meta‐analyses (random effects models) of pre‐, intra‐ and post‐operative factors associated with POPF in more than two studies were included. Results Among 52 774 patients All‐POPF (n = 69 studies) and CR‐POPF (n = 53 studies) affected 27% (95% confidence interval (CI95%) 23–30) and 19% (CI95% 17–22), respectively. Of the 176 factors, 24 and 17 were associated with All‐ and CR‐POPF, respectively. Absence of pre‐operative pancreatitis, presence of renal disease, no pre‐operative neoadjuvant therapy, use of post‐operative somatostatin analogues, absence of associated venous or arterial resection were associated with CR‐POPF but not All‐POPF. Conclusion In conclusion this study demonstrates wide variation in reported rates of POPF and that several risk factors associated with CR‐POPF are not used within risk prediction models. Data from this study can be used to shape future studies, research and audit across ethnic and geographic boundaries in POPF following pancreatoduodenectomy.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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“…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. The quality assessment of the included studies is reported in the Supplementary Table 2 (a-b) .…”

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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“…Difficult procedures and surgical experience deficiency can also cause anastomotic failure. In order to prevent the failure of pancreaticojejunostomy failure, several techniques have been used and evaluated [ 4 , 15 , 24 – 26 ], including the anastomotic site (the pancreaticojejunostomy and pancreatogastrostomy), direction of anastomosis (end-to-end and end-to-side), anastomosis layer (one layer or two layer or three layer anastomosis); suture method (interrupted suture, continuous suture, mattress suture, purse string suture and binding, etc. ), suture material improvement (silk suture, Vicryl or non traumatic suture), and application of the pancreatic stent tube, etc.. All these improved methods cannot fundamentally prevent pancreaticojejunostomy failure.…”

Section: Discussionmentioning

confidence: 99%

Chen’s penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy

Zhang

Zhu

et al. 2023

BMC Surg

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Background Postoperative pancreatic fistula (POPF) is the most serious complication and the main reason for morbidity and mortality after pancreaticoduodenectomy (PD). Currently, there exists no flawless pancreaticojejunal anastomosis approach. We presents a new approach called Chen’s penetrating-suture technique for pancreaticojejunostomy (PPJ), which involves end-to-side pancreaticojejunostomy by suture penetrating the full-thickness of the pancreas and jejunum, and evaluates its safety and efficacy. Methods To assess this new approach, between May 2006 and July 2018, 193 consecutive patients who accepted the new Chen’s Penetrating-Suture technique after a PD were enrolled in this study. Postoperative morbidity and mortality were evaluated. Results All cases recovered well after PD. The median operative time was 256 (range 208–352) min, with a median time of 12 (range 8–25) min for performing pancreaticojejunostomy. Postoperative morbidity was 19.7% (38/193) and mortality was zero. The POPF rate was 4.7% (9/193) for Grade A, 1.0% (2/193) for Grade B, and no Grade C cases and one urinary tract infection. Conclusion PPJ is a simple, safe, and reliable technique with ideal postoperative clinical results.

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Reliability of Continuous Suture of Pancreaticojejunostomy after Pancreaticoduodenectomy

Cited by 10 publications

References 0 publications

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Continuous irrigation after pancreatectomy: a systematic review

Chen’s penetrating-suture technique for pancreaticojejunostomy following pancreaticoduodenectomy

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