The Tight Adaptation at Pancreatic Anastomosis Without Parenchymal Laceration: An Institutional Experience in Introducing and Modifying the New Procedure

Oda, Tatsuya; Hashimoto, Shinji; Miyamoto, Ryoichi; Shimomura, Osamu; Fukunaga, Kiyoshi; Kohno, Keisuke; Ohshiro, Yukio; Akashi, Yoshimasa; Enomoto, Tsuyoshi; Ohkohchi, Nobuhiro

doi:10.1007/s00268-015-3075-8

Cited by 27 publications

(40 citation statements)

References 38 publications

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“…As shown in previous reports, male sex and a BMI of > 22 kg/m 2 were risk factors for CR-PF [ 17 ] in our study. Unlike in previous reports [ 7 , 8 , 18 ], there was no significant difference in the incidence of CR-PF between the Kakita and Blumgart anastomosis groups. Our hypothesis that Blumgart anastomosis is associated with a lower incidence of whole PF and higher incidence of latent PF was denied in this study.…”

Section: Discussioncontrasting

confidence: 99%

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Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

et al. 2018

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BackgroundPostoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. However, the optimal method remains unknown. This study was performed to clarify the impact of pancreatojejunostomy on clinically relevant PF (CR-PF) between Blumgart anastomosis and Kakita anastomosis in patients with a soft pancreas.MethodsIn total, 620 consecutive patients underwent pancreatoduodenectomy at our institute from January 2010 to December 2016, and 282 patients with a soft pancreas were analyzed (Blumgart anastomosis, n = 110; Kakita anastomosis, n = 176). Short-term outcomes were assessed, and univariate and multivariate analyses of several clinicopathological variables were performed to analyze factors affecting the incidence of CR-PF.ResultsThe CR-PF rate was 42.7% (122/286). The CR-PF rate was not significantly different between the Blumgart and Kakita groups (42.7% and 42.6%, respectively; p = 0.985). The morbidity rate (Clavien–Dindo grade ≥ IIIa) was 24.5% (70/286), and the operation-related mortality rate was 0.7% (2/286). In the multivariate analysis, male sex (p = 0.0245) and a body mass index of ≥22 kg/m2 (p < 0.0001) were statistically significant risk factors for CR-PF.ConclusionsThe CR-PF rate was not significantly different between patients treated with Kakita versus Blumgart anastomosis.

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Section: Discussioncontrasting

confidence: 99%

“…In recent decades, a new standardized U-suture technique, which was originally described by Blumgart et al [ 5 , 6 ] in 2000, has been improved and rapidly accepted. Several studies have demonstrated the superiority of Blumgart anastomosis over Kakita anastomosis [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

et al. 2018

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“…The early identification of patients at a high risk for clinically relevant POPF can increase the accuracy of preoperative benefit/risk assessment and the information given to patients. Furthermore, early identification should be useful for guiding technical and pharmacologic management practices, including perioperative nutritional support, imaging examinations for the early detection of abdominal abscesses, infection control, drainage tube management, and the administration of somatostatin analogs [11-13]. …”

Section: Discussionmentioning

confidence: 99%

“…Ideally, predictive factors should be determined preoperatively by objective parameters. Preoperative identification of patients at high risk of clinically relevant POPF can increase the accuracy of preoperative benefit/risk assessment and information given to patients and should enable surgeons to modify surgical procedures and perioperative management to reduce risk [11-13]. …”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Miyamoto

Oshiro

Sano

et al. 2018

Gastrointest Tumors

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Background: Postoperative pancreatic fistula (POPF) is a serious complication that can occur following pancreaticoduodenectomy (PD). Recent studies suggest that remnant pancreatic volume (RPV) values from preoperative multidetector computed tomography (MDCT) are highly predictive of POPF. We performed three-dimensional (3D) surgical simulation of PD including RPV measurements. The aim of this study was to determine whether 3D-measured RPV is predictive of POPF after PD. Methods: We used the SYNAPSE VINCENT® medical imaging system (Fujifilm Medical Co., Ltd., Tokyo, Japan) to construct 3D images after integrating MDCT and magnetic resonance cholangiopancreatography images. RPV was measured using this 3D image, which simulated actual intraoperative pancreatic parenchymal remnant volume. Ninety-one patients who underwent PD were retrospectively enrolled. Using multivariate analysis, RPV and other well-known POPF risk factors were independently assessed. Results: Multivariate analysis identified high RPV values (hazard ratio [HR] = 8.41, p = 0.01), pancreatic duct diameter < 3.0 mm (HR = 5.48, p < 0.01), no pathological fibrosis (HR = 3.41, p < 0.01), and body mass index > 25 kg/m² (HR = 1.53, p = 0.02) as independent risk factors for POPF. Conclusion: The present study indicates that preoperative 3D-measured RPV is predictive of POPF after PD.

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“…Two major PJ reconstructions of Kakita method and Blumgart's technique have been reported [18][19][20][21]. Oda et al reported that the rate of ISGPF grade B+C PF was 29/78 (37.2%) in the Kakita group and 16/78 (20.5%) in the Blumgart group (P = 0.033) [22]. The principal technique of these two methods is a tight adaptation of pancreatic parenchyma and duodenal seromusuclaris.…”

Section: Groupmentioning

confidence: 99%

New Surgical Procedure for Pancreas Head

Sato¹,

Hara²,

Sawada³

et al. 2017

Challenges in Pancreatic Pathology

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In this study, we demonstrate two new methods for pancreaticoduodenectomy (PD). One method is the mini-laparotomic PD by Shuriken-shaped umbilicoplasty with the real-time moving window's method. The other method is the new pancreaticojejunostomy (PJ) by punctured stent slide guiding method (PSSGM). This procedure could be performed by complete mini-laparotomy under direct vision, and the inal major wound is only 2 cm of round navel. PSSGM prevents the diference of caliber between pancreatic anastomosis and the inside out of jejunal mucosa in theory. Ten cases of mini-lap PD were successfully performed under new PJ anastomosis. The pancreatic leakage (PL) was only one case of ISGPF grade A, and its frequency was 9% (1/11). Our mini-lap PD by Shuriken-shaped umbilicoplasty might be a useful way for overcoming the obstacles about safety, complication risk, cosmetic demand, and medical cost compared to laparoscopic PD. Also, our new device of PJ reconstruction by PSSGM might be an easy and useful device for the prevention of PL.

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The Tight Adaptation at Pancreatic Anastomosis Without Parenchymal Laceration: An Institutional Experience in Introducing and Modifying the New Procedure

Cited by 27 publications

References 38 publications

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

New Surgical Procedure for Pancreas Head

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