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Smyrniotis V, Parasyris S, Gemenetzis G, Margaris I, Petropoulou Z, Papadoliopoulou M, Sidiropoulos T, Dellaportas D, Vezakis A, Polydorou A, Kokoropoulos P, Theodoraki K, Matsota P, Vassiliu P, Arkadopoulos N. Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy: The Role of the Roux-en-Y Configuration. ANNALS OF SURGERY OPEN 2022; 3:e161. [PMID: 37601609 PMCID: PMC10431257 DOI: 10.1097/as9.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients' outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients' outcome. Methods The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed. Results Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively (P = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively (P = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively (P = 0.02 A vs B+C). Conclusion Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH.
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Affiliation(s)
- Vasileios Smyrniotis
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Parasyris
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Gemenetzis
- Hepatobiliary and Pancreatic Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom
| | - Ioannis Margaris
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Petropoulou
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Papadoliopoulou
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Sidiropoulos
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Dellaportas
- Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Vezakis
- Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Polydorou
- Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokoropoulos
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kassiani Theodoraki
- Department of Anesthesiology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Matsota
- Department of Anesthesiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panteleimon Vassiliu
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Arkadopoulos
- From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Wu T, Guo Y, Bi J, Liu S, Guo Y, Bao S. Modified duct-to-mucosa versus conventional pancreaticoenterostomy for pancreaticoduodenectomy: a retrospective cohort study based on propensity score matching analysis. World J Surg Oncol 2019; 17:5. [PMID: 30611270 PMCID: PMC6320616 DOI: 10.1186/s12957-018-1557-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the most common neopathy after pancreatoduodenectomy (PD). An ideal pancreaticoenterostomy (PE) which can effectively reduce the incidence of CR-POPF and its potential neopathy is needed. We aimed to assess the efficacy of our modified duct-to-mucosa PE in the PD. METHOD From January 2011 to December 2017, 233 consecutive patients with PD were retrospectively included from Shenzhen People's Hospital. After propensity score matching (PSM), there were 82 patients in both the modified duct-to-mucosa PE group (group A) and the conventional end-to-side inserting PE group (group B), respectively. The clinical course and the incidence of postoperative neopathy were compared between groups. Logistic regression method was utilized to analyze the association between PE approach and CR-POPF. RESULTS The PE time was shorter in group A (9.3 ± 1.8 min vs. 21.5 ± 2.8 min, P < 0.001). The group A had significantly lower incidence of severe neopathy (Clavien-Dindo grade > II) [7.3% (5/82) vs. 17.1% (14/82), P = 0.028] and incidence of CR-POPF [1.2% (1/82) vs. 19.5% (12/82), P < 0.001] than the group B. Our modified duct-to-mucosa PE technique was associated with a reduced risk for CR-POPF (OR, 0.11 [95% CI, 0.02-0.57]; P = 0.009) as compared with the conventional end-to-side inserting PE. CONCLUSION Compared with conventional end-to-side inserting PE, our modified duct-to-mucosa PE technique can effectively reduce the incidences of postoperative neopathy and CR-POPF. TRIAL REGISTRATION Researchregistry3877 . Registered 24 March 2018. Retrospectively registered.
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Affiliation(s)
- Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China
| | - Yuehua Guo
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China
| | - Jiangang Bi
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China
| | - Shuwang Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China
| | - Yusheng Guo
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China
| | - Shiyun Bao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong Province, China.
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Magoga G, Felder L, Palazzo F, Berghella V. Pregnancy after Whipple procedure: a new case and review of the literature. J Matern Fetal Neonatal Med 2018; 33:344-348. [PMID: 29895203 DOI: 10.1080/14767058.2018.1488959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Whipple procedure is a complex operation usually performed to treat periampullary neoplasms. There are only four case reports of five pregnancies after Whipple procedure, with limited evidence about how to manage pregnancy after this surgery.Case: A 28-year-old gravida 5 Para 2022 presented to our hospital at 20 weeks with worsening depression. She had a history of Whipple for a solid pseudopapillary neoplasm of the pancreas followed by two pregnancies. In the first, she underwent successful induction of labor at 38 weeks for pregestational diabetes. In her second pregnancy, she had multiple admissions for diabetic ketoacidosis. She was scheduled for induction of labor at 35 weeks but given unstable lie, underwent cesarean delivery.Conclusion: Women with a history of Whipple procedure generally have successful pregnancies with the most common antenatal complications including diabetes mellitus, abdominal pain and pancreatitis/cholangitis.
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Affiliation(s)
- Giulia Magoga
- Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy
| | - Laura Felder
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Palazzo
- Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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