The linear cutting stapler for enteric anastomosis: a new technique in pancreas transplantation

Abstract

Summary The drainage of pancreatic exocrine secretions following pancreas transplantation is an evolving area of surgical practice. We describe a new technique applying a 55 mm Linear Cutting Stapler (LCS) to create the duodenoenterostomy for enteric drainage of the pancreas transplant. Twenty simultaneous pancreas and kidney transplantations performed between April 2005 and March 2006 were reviewed. Using a prospective database and chart review, complications and outcome related to the new technique of exocrine drainage were described. During this 12 month period, 19 of 20 consecutive simultaneous pancreas and kidney transplantations have been performed using the linear cutting stapler techinque. No complications relating to the enteric anastomosis have been demonstrated. In our initial experience, use of the LCS is both safe and easy to perform.

Exocrine drainage in vascularized pancreas transplantation in the new millennium

“…However, with time and experience, most pancreas transplant surgeons evolved to directing the head and duodenum of the pancreas allograft away from the pelvis to simplify the enteric anastomosis, which was typically performed side-to-side between the allograft duodenum and either the recipient proximal jejunum or ileum without a Roux limb (Table 6) [104][105][106][107][108] ( Figure 3). Safe techniques of using either the circular or linear stapler were described to simplify the enteric anastomosis [109,110] . If a Meckel's diverticulum was identified, some surgeons would excise the diverticulum and then use this site for the bowel anastomosis [111] .…”

“…Following reperfusion of the transplanted pancreas, if the allograft duodenum does not appear well vascularized, bowel drainage with creation of a diverting Roux limb may be preferred to bypass the enteric stream and promote healing even though this procedure mandates an additional bowel anastomosis. Although the rate of bleeding at the may be higher, some surgeons prefer to use either a circular or linear stapling device to create the bowel anastomosis [109,110] . However, most commonly, the connection between the allograft duodenum and recipient small bowel is performed using a 2-layer hand sewn technique that comprises a running continuous inner layer of interlocking absorbable suture coupled with an interrupted seromuscular outer layer of simple interrupted nonabsorbable sutures to create a "watertight" and hemostatic closure [121] .…”

“…In 3 successive eras, kidney graft survival was 77%, 93%, and 94%, respectively; pancreas graft survival was 60%, 83%, and 83%, respectively Università di Pisa, Italy, Boggi et al [17] , Retrospective, mean follow-up 21 ± 20 mo PE 110 10 grafts were lost; 3 acute rejection, 2 chronic rejection, 2 venous thrombosis, 2 deaths, 1 late thrombosis (6 mo). Incidence of pancreas acute rejection was 6%…”

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

“…Внедрение в клиническую практику консервирующего раствора UW, использование такролимуса, индукционной те-рапии моно-и поликлональными антителами, при-менение антибиотиков новых поколений, широкое использование в повседневной практике биопсии, ультразвукового исследования и компьютерной томографии позволило вновь вернуться к технике кишечного дренирования [66]. Использование этой более физиологичной техники дренирования было с энтузиазмом поддержано медицинским сообщес-твом, что привело наряду с другими факторами к увеличению количества трансплантаций поджелу-дочной железы [63,69,70].…”

Surgical Morbidity of Simultaneous Kidney and Pancreas Transplantation: A Single-Centre Experience in the Tacrolimus Era

“…To achieve this, the donor duodenum segment and recipient jejunum were anastomosed in a side-to-side con�guration. In most cases, this was fashioned in two layers using a 3-0 mono�lament absorbable suture although a small number were performed with linear cutting stapler [6]. For bladder-drained pancreases, the donor duodenum segment was anastomosed to the dome of the urinary bladder using 3-0 mono�lament absorbable suture.…”