Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Jakhmola, C.K.; Kumar, Ameet

doi:10.1016/j.mjafi.2014.08.011

Cited by 28 publications

(33 citation statements)

References 21 publications

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“…Low-risk patients are associated with dilated pancreatic duct or firm, fibrotic parenchyma. Patients with small duct but fibrotic parenchyma are considered as low risk [15,18] [ Table 1]. …”

Section: Risk Factorsmentioning

confidence: 99%

Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review

Conzo

Gambardella

Tartaglia

et al. 2015

International Journal of Surgery

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Pancreatoduodenectomy is the gold standard operation for malignant and benign diseases of the pancreas and periampullary region. Even if improvements in intensive care management and surgical technique have dramatically reduced postoperative mortality after pancreatic surgery, morbidity remains high (30-50%), also in specialized pancreatic units. In order to reduce postoperative complications, particularly pancreatic fistula, different surgical techniques and their modifications have been proposed. In order to determine the better management of the pancreatic stump after pancreatoduodenectomy, the Authors analysed and compared derivative - pancreaticojejunal, pancreaticogastrostomy - vs no-derivative technique - pancreatic stump closure (duct ligation or mechanical suture, duct occlusion by fibrin glue or cyanoacrylate). A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, analysing the risk factors and the incidence of short-medium term postoperative complications. Up to now, even if derivative procedures are preferred as gold standard the best method to deal a pancreatic stump is still controversial and remains matter of research. Pancreatic surgeons must have more than one technique for managing the pancreatic remnant.

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Section: Risk Factorsmentioning

confidence: 99%

Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review

Conzo

Gambardella

Tartaglia

et al. 2015

International Journal of Surgery

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“…Abdominal magnetic resonance imaging (MRI) and endo-ultrasonography were performed for selected patients [9,10]. Pre-operative biliary drainage was done with ERCP if the serum bilirubin was more than 20 mg/dl or if the patient had fever because of acute cholangitis [11,12].…”

Section: Pre-operative Wok Upmentioning

confidence: 99%

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Agrusa

Gallucci

Buono

et al. 2015

International Journal of Surgery

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a b s t r a c tIntroduction: Pancreatic cancer is the fourth cause of death from cancer in Western countries. The radical surgical resection is the only curative option for this pathology. The prevalence of this disease increases with age in population. The causes of pancreatic cancer are unknown, but we consider risk factors like smoke and tobacco usage, alcohol consumption coffee, history of diabetes or chronic pancreatitis. In this study we report our experience in the treatment of resectable pancreatic cancer and periampullary neoplasms with particular attention to evaluate the evolution of surgical technique and the clinical postoperative outcomes. Methods: In our Department between January 2010 and December 2014 we performed a total of 97 pancreaticoduodenectomy. We considered only resectable pancreatic cancer and periampullary neoplasms defined by absence of distant metastases, absence of local tumor extension to the celiac axis and hepatic artery as the lack of involvement of the superior mesenteric vasculature. None of these patients received neoadjuvant chemotherapy. Results: The mean age of these patients was 64.5 years. Jaundice was the commonest presenting symptom associated to anorexia and weight loss. The mean operative time was 295 min (±55 min). The mean blood loss was 450 ml and median blood transfusion was 1 units. 12.1% of patients had an intraabdominal complication. The commonest complication was Delayed Gastric Emptying responsable of increased length of hospital stay and readmission rate. Postoperative pancreatic fistula of grade C occurred in 4 patients. 2 patients developed a postpancreatectomy hemorrhage. Perioperative mortality was 4.1%. Conclusion: Pancreaticoduodenectomy is a complex surgical technique and the associated high morbidity and mortality resulted in initial reluctance to adopt this surgery for the management of pancreatic and periampullary tumors. Surgical outcomes of pancreatic surgery are better at high-volume experienced center reporting mortality rates below 5%. We perform an end-to-side duct-to-mucosa pancreaticojejunostomy with routinely use of internal pancreatic stent. However no one technique has been shown to definitely be the solution to the problem of postoperative pancreatic fistula. At our center we have a reasonable volume and our data are comparable to literature data.

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“…Pancreaticoduodenectomy (PD) is one of the most complex, formidable surgery commonly performed for pancreatic head and periampullary tumors and occasionally for benign conditions like chronic pancreatitis and pancreato-duodenal trauma. 1,2 Carcinoma of the head of pancreas is the most common indication for PD. Recently with its improved safety profile PD is now also considered as an suitable treatment option for selected patients with chronic pancreatitis; which is now constituting the second most common indication for this operation.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Since the 1980s combined improvement in surgical, anaesthetic/critical care management and interventional radiological techniques resulted in a steady and consistent fall of perioperative mortality rates and currently reported rates are below 5% in high volume centers. 2 Despite dramatic decrease in mortality rates the post-operative morbidity continues to remain high, ranging from 30%-60%. 1 Major post operative complications of PD include, post-operative pancreatic fistulas (POPF), bile leakage, delayed gastric emptying (DGE), post pancreatomy hemorrhage (PPH) and complications related to the surgical site: such as infection and wound dehiscence.…”

Section: Introductionmentioning

confidence: 99%

Whipple's pancreaticoduodenectomy: perioperative outcomes in a tertiary care hospital in Dhaka, Bangladesh

et al. 2021

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Background: Pancreaticoduodenectomy is one of the most complex surgery with significant mortality and morbidity. Though the mortality rate has steadily improved, morbidity continues to be high. The aim of this study was to demonstrate the perioperative outcome following this procedure at our hospital.Methods: This retrospective study was conducted in the department of Surgery, Sir Salimullah medical college and Mitford hospital from July 2018 to December 2019. A total of 29 patients who undergone pancreaticoduodenectomy were included in the study. Preoperative, intra-operative and post-operative data were analyzed with emphasis on the morbidity and mortality rates. None of the operated patients received any types of neoadjuvant therapy.Results: Out of 29 patients who underwent PD, 18 (62.1%) were male and 11 (37.9%) were female with a median age of 53.7 years. The most common (34.5%) age group of the patients were 51-60 years. Jaundice was the commonest (89.7%) presenting symptoms followed by anorexia (75.9%) and abdominal pain (48.3%). Overall complications occurred in 37.9% patients, including wound infections (31.0%) and post-operative pancreatic fistula (6.9%). The post-operative mortality rate was 6.9%.Conclusions: PD still causes considerable morbidity and mortality. With careful patient selection, adequate preoperative preparation, surgical technique, excellent critical care management PD can be performed safely. At our center we have a reasonable volume and our data are comparable to literature data.

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Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Cited by 28 publications

References 21 publications

Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review

Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Whipple's pancreaticoduodenectomy: perioperative outcomes in a tertiary care hospital in Dhaka, Bangladesh

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