The Evaluation of Duct‐to‐mucosal Pancreaticojejunostomy in pancreaticoduodenectomy

Tani, Masaji; Onishi, Hironobu; Kinoshita, Hiroyuki; Kawai, Manabu; Ueno, Masaki; Hama, Takashi; Uchiyama, Kazuhisa; Yamaue, Hiroki

doi:10.1007/s00268-004-7507-0

Cited by 73 publications

(60 citation statements)

References 26 publications

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“…Many previous reports have proposed that hard texture of the pancreatic parenchyma and a dilated pancreatic duct have a lower risk of pancreatic fistula formation owing to an ability to prevent pancreatic duct dilatation and shrinkage of the pancreaticojejunostomy after PD [16] . Conversely, in the case of a small pancreatic duct and a soft pancreas, an end-to-end invagination anastomosis or binding pancreaticojejunostomy significantly decreases postoperative complications [20,27] .…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of pancreatic fistulas remains a major cause of postoperative complications; it is reported that the incidence of pancreatic fistulas after PD is 6%-25% [4][5][6][7][8][9][10][11][12] . It is known that such pancreatic fistulas induce abscess formation, vascular injuries, rupture of pseudoaneurysms, and postoperative delayed hemorrhage, all resulting from inflammation around leakage sites due to stasis of fluid, including active pancreatic enzymes [13][14][15][16] . The aim of this study was to analyze the independent risk factors for pancreatic fistulas after PD.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy

Choe¹,

Lee²,

Oh³

et al. 2008

WJG

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AIM:To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS:We r e t r o s p e c t i v e l y r e v i e w e d 1 7 2 consecutive patients who had undergone pancreaticoduodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods. RESULTS: The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% (25/115), while the incidence was 8.8% (5/57) for younger patients; the difference was significant (P = 0.03). Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct (P = 0.001). Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION: O u r s t u d y d e m o n s t ra t e d t h a t pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy

Choe¹,

Lee²,

Oh³

et al. 2008

WJG

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“…Among them, a small pancreatic duct size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage [3,[8][9][10][11][12][13] . Several methods have been advocated to reduce the occurrence of leakage [5,[14][15][16][17][18][19][20][21] , but the best technique is still a subject of debate [22][23][24][25][26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

Hakamada¹,

Narumi²,

Toyoki³

et al. 2008

WJG

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AIM:To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fastabsorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture. METHODS:Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fastabsorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis. RESULTS:The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen. CONCLUSION:A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas. Hakamada K, Narumi S, Toyoki Y, Nara M, Ishido K, Miura T, Kubo N, Sasaki M. An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture.

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“…2 The incidence of pancreatic fistula is as high as 24% and it can lead to bleeding, abscess, sepsis and death. [3][4][5][6] Published studies have reported inconsistent outcomes with regards to the effectiveness of internal versus external pancreatic stenting in a patient with pancreaticojejunal anastomosis. There was no substantial variation in morbidity, mortality and hospital stay between the external and the internal pancreatic duct stent groups.…”

Section: Discussionmentioning

confidence: 99%