The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury

Wen, Xudong; Liu, Danqing; Zhang, Bingyin; Le, Xiao Feng; Yan, Hong-tao; Liu, Weihui

doi:10.1007/s13304-020-00807-5

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…In recent years, some authors have attempted to directly support the MPD with stents for pancreatic duct anastomosis and achieved good results. [ 8 , 14 , 15 ] Since stents were placed under direct vision during surgery as reported in the literature, [ 8 , 10 , 14 ] it was not easy to place stents with a small diameter of MPD. Even if the diameter of MPD is normal, small-diameter stents should be selected for convenient placement.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] More recently, bridge stenting along the injured MPD has been employed with success. [ 8 ] However, limited cases have been reported on hybrid surgery- endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct for pancreatic neck injuries. In this study, we present a case of a 63-year-old male patient who underwent hybrid surgery to address a complete transection of the pancreas at the head and neck.…”

Section: Introductionmentioning

confidence: 99%

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Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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Introduction: A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD. Patient concerns: A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck. Diagnoses: Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV. Interventions: The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct. Outcomes: The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction. Lessons: The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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“…In addition, close to the pancreatic section and jejunal tube can eliminate potential space, help reduce pancreatic juice extravasation, and thus reduce the possibility of a pancreatic fistula. The classic end-to-side anastomosis of the pancreatic duct and jejunal mucosa uses fine suture to connect the pancreatic duct and jejunal mucosa, which has advantages for the patency of pancreatic drainage and the environment of tissue healing [30]. However, there are many limitations for its use in laparoscopic anastomosis, as it often cannot achieve its optimal effect as in open surgery, and it is time consuming and especially unfriendly for beginners.…”

Section: Discussionmentioning

confidence: 99%

A novel anastomosis technique facilitates pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (with video)

Zhou

Yang

Wei

et al. 2021

Langenbecks Arch Surg

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Background While the best technique for pancreatic anastomosis during Whipple's procedure remains controversial, laparoscopic pancreaticoduodenectomy (LPD) has been rapidly increasing in popularity. Because of their feasibility and reliability, new pancreatic anastomosis techniques may have vital roles when adapted for LPD. Here, we describe a new pancreaticojejunostomy (PJ) technique using three sutures (termed the "three sutures" PJ technique), which facilitates pancreatic anastomosis during total LPD. Methods A total of 149 patients who underwent LPD using the "three sutures" PJ technique at three hospitals were included in this study (81 patients at Guangdong Provincial People's Hospital [GDPH], 60 patients at Sun Yat-Sen Memorial Hospital [SMH], and 8 patients at Affiliated Hospital of Guangdong Medical University [AHGMU]). Data on the demographic characteristics, operative outcomes, and postoperative results (pancreatic fistula rate, mortality rate, and length of hospital stay) of these patients were collected and analyzed. Results A surgical video showing the details of the "three sutures" PJ method was included. The mean operation times at GDPH, SMH, and AHGMU were 4.08 ± 0.99 h, 4.65 ± 1.53 h, and 4.67 ± 0.64 h, respectively, and the average PJ times were 17.96 ± 3.49 min, 18.19 ± 2.63 min, and 22.5 ± 3.96 min, respectively. The numbers of grade B pancreatic fistulas were 9 (11.11%), 2 (3.33%), and 1 (12.50%), respectively, and two patients had grade C fistulas, one each at GDPH and SMH. The numbers of clinically relevant postoperative pancreatic fistula (CR-POPF) were 10 (12.35%), 3 (5.00%), and 1 (12.50%) in each center, respectively. The overall rate of CR-POPF was 9.40% (14/149) among patients of all three centers. The perioperative mortality rate was 0%. Conclusions The "three sutures" PJ technique for total LPD is a safe and reliable method, with a low risk of pancreatic fistula, short anastomosis time, and steep learning curve.

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“…Percutaneous drainage (PCD), without open the retroperitoneum, can be used as the initial management for pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis caused by hollow organ injury. [23,29] Subsequently, ERCP-guided stent placement was performed along the injured MPD for internal drainage [5,17,23,30,31]. NOM strategies combined with internal and external drainage is thought to be bene cial in the acute and delayed phase by inducing less surgical stress, thereby lowering the in ammatory cascade, especially in already critically ill patients with serious injury [25,31,32].…”

Section: Introductionmentioning

confidence: 99%

Open or Not Open the Retroperitoneum: A Pandora’s Box for High-Grade Pancreatic Trauma?

Ding

2023

Journal of the American College of Surgeons

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Background: The management strategy associated with the optimal clinical outcomes for patients with pancreatic trauma remains ambiguous. We sought to determine whether transitioning from initial laparotomy (LAP) to the nonoperative management strategy based on initial percutaneous drainage (PCD) without opening the retroperitoneum would improve clinical outcomes in patients with blunt highgrade pancreatic trauma.Methods: We conducted a retrospective cohort study of pancreatic trauma at a single tertiary referral center. Blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis were enrolled consecutively in the study. The primary outcome measure was the incidence of severe complications (Clavien-Dindo classi cation ≥ b) for patients who underwent initial LAP vs PCD. To study effect modi cation by different initial strategies and to adjust for confounding, modi ed Poisson regression and sensitivity analysis based on propensity score matching and weighting were performed to estimate adjusted relative risks (aRR) and 95% con dence intervals (CIs).Results: Among 119 patients with blunt grade / pancreatic trauma (107 male [89.9%] and 12 female [10.1%]; mean age, 35.7 [SD, 12.7] years), 29 underwent initial PCD and 90 underwent initial LAP (January 2009 through October 2021). Compared with initial LAP, patients underwent initial PCD were signi cantly lower risk of severe complicates (9/29 [31.0%] vs 65/90 [72.2%]; aRR, 0.52 [95% CI, 0.30-0.90]). Consistent results are also observed in sensitivity analysis models. The relative risk of severe complications for the PCD group in propensity score matching model was 0.53 (95% CI, 0.28-0.99; P = 0.035), 0.37 (95% CI, 0.18-0.75; P = 0.006) in inverse probability of treatment weighting model, and 0.55 (95% CI, 0.31-0.99; P = 0.046) in overlap weighting model. In addition, the mean number of reinterventions per patient was 1.8 in the PCD group and 2.6 in the LAP group (P = 0.067).Conclusions: For blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis, initial PCD strategy without open the retroperitoneum has a signi cantly lower rate of severe complications and does not increase reinterventions compared with initial LAP. Further randomized controlled trials are warranted to validate these results.

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The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury

Cited by 8 publications

References 28 publications

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

A novel anastomosis technique facilitates pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (with video)

Open or Not Open the Retroperitoneum: A Pandora’s Box for High-Grade Pancreatic Trauma?

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