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Mastalier B, Cauni V, Tihon C, Septimiu Petrutescu M, Ghita B, Popescu V, Andras D, Radu IM, Vlasceanu VG, Floroiu MF, Draghici C, Botezatu C, Cretoiu D, Varlas VN, Lazar AM. Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score. J Clin Med 2023; 12:6193. [PMID: 37834836 PMCID: PMC10573877 DOI: 10.3390/jcm12196193] [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: 08/12/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Despite the substantial decrease in mortality rates following a pancreaticoduodenectomy to less than 5%, morbidity rates remain significant, reaching even 73%. Postoperative pancreatic fistula is one of the most frequent major complications and is significantly associated with other complications, including patient death. Currently, there is no consensus regarding the ideal type of pancreatic anastomosis, as the question of the choice between a pancreaticogastrostomy and pancreaticojejunostomy is still open. Furthermore, worldwide implementation of an ideal pancreatic fistula risk prediction score is missing. Our study found several significant predictive factors for the postoperative occurrence of fistulas, such as the soft consistency of the pancreas, non-dilated Wirsung duct, important intraoperative blood loss, other perioperative complications, preoperative patient hypoalbuminemia, and patient weight loss. Our study also revealed that for patients who exhibit fistula risk factors, pancreaticogastrostomy demonstrates a significantly lower pancreatic fistula rate than pancreaticojejunostomy. The occurrence of pancreatic fistulas has been significantly associated with the development of other postoperative major complications, and patient death. As the current pancreatic fistula risk scores proposed by various authors have not been consensually validated, we propose a simple, easy-to-use, and sensitive score for the risk prediction of postoperative pancreatic fistula occurrence based on important predictors from statistical analyses that have also been found to be significant by most of the reported studies. The new pancreatic fistula risk score proposed by us could be extremely useful for improved therapeutic management of cephalic pancreaticoduodenectomy patients.
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Affiliation(s)
- Bogdan Mastalier
- Department of Surgery, Department of Functional Sciences, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (B.M.); (V.P.); (D.A.); (C.B.); (A.M.L.)
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Victor Cauni
- Urology Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Constantin Tihon
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Marius Septimiu Petrutescu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Bogdan Ghita
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Valentin Popescu
- Department of Surgery, Department of Functional Sciences, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (B.M.); (V.P.); (D.A.); (C.B.); (A.M.L.)
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Dan Andras
- Department of Surgery, Department of Functional Sciences, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (B.M.); (V.P.); (D.A.); (C.B.); (A.M.L.)
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Ion Mircea Radu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Vasile Gabriel Vlasceanu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Marius Florian Floroiu
- Anaesthesia Intensive Care Unit, Colentina Clinical Hospital, 020125 Bucharest, Romania; (M.F.F.); (C.D.)
| | - Cristian Draghici
- Anaesthesia Intensive Care Unit, Colentina Clinical Hospital, 020125 Bucharest, Romania; (M.F.F.); (C.D.)
| | - Cristian Botezatu
- Department of Surgery, Department of Functional Sciences, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (B.M.); (V.P.); (D.A.); (C.B.); (A.M.L.)
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
| | - Dragos Cretoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Angela Madalina Lazar
- Department of Surgery, Department of Functional Sciences, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (B.M.); (V.P.); (D.A.); (C.B.); (A.M.L.)
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (C.T.); (M.S.P.); (B.G.); (I.M.R.); (V.G.V.)
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2
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Chui JN, Sahni S, Samra JS, Mittal A. Postoperative pancreatitis and pancreatic fistulae: a review of current evidence. HPB (Oxford) 2023; 25:1011-1021. [PMID: 37301633 DOI: 10.1016/j.hpb.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Postoperative pancreatic fistula (POPF) represents one of the most severe complications following pancreatic surgery. Despite being a leading cause of morbidity and mortality, its pathophysiology is poorly understood. In recent years, there has been growing evidence to support the role of postoperative or post-pancreatectomy acute pancreatitis (PPAP) in the development of POPF. This article reviews the contemporary literature on POPF pathophysiology, risk factors, and prevention strategies. METHODS A literature search was conducted using electronic databases, including Ovid Medline, EMBASE, and Cochrane Library, to retrieve relevant literature published between 2005 and 2023. A narrative review was planned from the outset. RESULTS A total of 104 studies fulfilled criteria for inclusion. Forty-three studies reported on technical factors predisposing to POPF, including resection and reconstruction technique and adjuncts for anastomotic reinforcement. Thirty-four studies reported on POPF pathophysiology. There is compelling evidence to suggest that PPAP plays a critical role in the development of POPF. The acinar component of the remnant pancreas should be regarded as an intrinsic risk factor; meanwhile, operative stress, remnant hypoperfusion, and inflammation represent common mechanisms for acinar cell injury. CONCLUSIONS The evidence base for PPAP and POPF is evolving. Future POPF prevention strategies should look beyond anastomotic reinforcement and target underlying mechanisms of PPAP development.
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Affiliation(s)
- Juanita N Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia
| | - Sumit Sahni
- Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, Sydney, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, Sydney, Australia; School of Medicine, The University of Notre Dame, Sydney, Australia.
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Teres ligamentum wrap covering the pancreaticojejunostomy following pancreatoduodenectomy is associated with a lower rate of postoperative pancreas fistula: a prospective cohort study. HPB (Oxford) 2023; 25:116-123. [PMID: 36280427 DOI: 10.1016/j.hpb.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 10/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-operative pancreas fistula (POPF) is a common complication after pancreatoduodenectomy (PD). A Teres Ligamentum (TL)-wrap covering the pancreaticojejunostomy (PJ) is suggested as a potential solution to reduce POPF. The aim of this study was to compare POPF incidence (grade B/C) in patients with or without a TL-wrap. METHODS A prospective cohort study was performed between January 2019-December 2021. All consecutive patients were included. Patient, tumor and surgical characteristics and postoperative complications were compared in both open and robot-assisted surgery. RESULTS A total of 118 consecutive patients were included. The first 57 patients were treated without and the following 61 patients with a TL-wrap. There were no statistically significant differences between both groups regarding patient, pre-operative treatment and surgical characteristics. The occurrence of POPF was strongly reduced in the TL-wrap group compared to patients without a TL-wrap (3.3% vs 28.1%, P < 0.001). Also mean length of hospital stay was reduced (11.5 vs 18.8 days, P = 0.030). CONCLUSION The use of a TL-wrap covering the PJ as addition to the modified Blumgart anastomosis technique is associated with a significantly reduced POPF rate and a reduced length of hospital stay. A TL-wrap is a simple addition to a PJ that may be considered to improve postoperative outcome. This association must be studied more definitively in a randomized controlled trial.
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Yu J, Ren CY, Wang J, Cui W, Zhang JJ, Wang YJ. Establishment of risk prediction model of postoperative pancreatic fistula after pancreatoduodenectomy: 2016 edition of definition and grading system of pancreatic fistula: a single center experience with 223 cases. World J Surg Oncol 2021; 19:257. [PMID: 34461923 PMCID: PMC8404268 DOI: 10.1186/s12957-021-02372-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/12/2021] [Indexed: 01/30/2023] Open
Abstract
Objective To establish a risk prediction model for pancreatic fistula according to the pancreatic fistula standards of the 2016 edition. Methods Clinical data from 223 patients with PD admitted to Tianjin Third Central Hospital from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into modeling (January 2016 to December 2018) and validation (January 2019 to December 2020) sets according to the time of admission. The risk factors for postoperative pancreatic fistula (POPF) were screened by univariate and multivariate logistic regression analyses, and a risk prediction model for POPF was established in the modeling set. This score was tested in the validation set. Results Logistic regression analysis showed that the main pancreatic duct index and CT value were independent risk factors according to the 2016 pancreatic fistula grading standard, based on which a risk prediction model for POPF was established. Receiver operating characteristic curve analysis showed that the area under the curve was 0.775 in the modeling set and 0.848 in the validation set. Conclusion The main pancreatic duct index and CT value of the pancreas are closely related to the occurrence of pancreatic fistula after PD, and the established risk prediction model for pancreatic fistula has good prediction accuracy.
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Affiliation(s)
- Jun Yu
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Third Central Hospital of Tianjin, Tianjin, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Third Central Hospital of Tianjin, 83 Jintang Road, Tianjin, 300170, China
| | - Chao-Yi Ren
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Third Central Hospital of Tianjin, Tianjin, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Third Central Hospital of Tianjin, 83 Jintang Road, Tianjin, 300170, China
| | - Jun Wang
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China
| | - Wei Cui
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Third Central Hospital of Tianjin, Tianjin, China
| | - Jin-Juan Zhang
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Third Central Hospital of Tianjin, 83 Jintang Road, Tianjin, 300170, China
| | - Yi-Jun Wang
- Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin, China. .,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Third Central Hospital of Tianjin, Tianjin, China. .,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Third Central Hospital of Tianjin, 83 Jintang Road, Tianjin, 300170, China.
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5
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Dalgatov KD, Kurskov AO, Khalbaginov AA, Sazhin AV. [Pancreatodigestive anastomosis: from history to modernity]. Khirurgiia (Mosk) 2021:81-86. [PMID: 34608784 DOI: 10.17116/hirurgia202110181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This review is devoted to history of pancreatodigestive anastomoses (PDA), technique of the most popular PDA, causes of pancreatic fistula and its prevention. Contradictory data were obtained in randomized trials and meta-analyses devoted to pancreatic anastomoses. There is no optimal anastomosis excluding clinically significant postoperative pancreatic fistula. Therefore, further studies should be aimed at new approaches reducing the incidence of clinically significant postoperative pancreatic fistula.
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Affiliation(s)
- K D Dalgatov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A O Kurskov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Khalbaginov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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6
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Bakheet N, Park JH, Shin SH, Hong S, Park Y, Shim IK, Hwang C, Jeon JY, Lopera JE, Song HY, Kim SC. A Novel Biodegradable Tubular Stent Prevents Pancreaticojejunal Anastomotic Stricture. Sci Rep 2020; 10:1518. [PMID: 32001759 PMCID: PMC6992790 DOI: 10.1038/s41598-019-57271-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
Stricture of pancreatic-enteric anastomoses is a major late complication of a pancreaticoduodenectomy for the treatment of a periampullary tumor and can lead to exocrine and endocrine insufficiency such as malnutrition and diabetes mellitus. We investigated the safety and efficacy of a biodegradable tubular stent (BTS) for preventing a pancreaticojejunostomy (PJ) anastomotic stricture in both a rat and porcine model. The BTS was manufactured using a terpolymer comprising poly p-dioxanone, trimethylene carbonate, and glycolide. A cohort of 42 rats was randomized into 7 groups of 6 animals each after BTS placement into the duodenum for the biodegradation assay. A total of 12 pigs were randomized equally into a control and BTS placement group. The effectiveness of the BTS was assessed by comparing radiologic images with histologic results. Surgical procedures and/or BTS placements were technically successful in all animals. The median mass losses of the removed BTS samples from the rat duodenum were 2.1, 6.8, 11.2, 19.4, 26.1, and 56.8% at 1, 2, 3, 4, 6, and 8 weeks, respectively. The BTS had completely degraded at 12 weeks in the rats. In the porcine PJ model, the mean luminal diameter and area of the pancreatic duct in the control group was significantly larger than in the BTS group (all p < 0.05). BTS placement thus appears to be safe and effective procedure for the prevention of PJ anastomotic stricture. These devices have the potential to be used as a temporary stent placement to treat pancreatic-enteric anastomoses, but further investigations are required for optimization in human.
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Affiliation(s)
- Nader Bakheet
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Gastrointestinal Endoscopy and Liver unit, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang Hyun Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sarang Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yejong Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - In Kyong Shim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Changmo Hwang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Asan Medical Institute of Convergence Science and Technology (AMIST), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jorge E Lopera
- Department of Radiology, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Song Cheol Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
- Asan Medical Institute of Convergence Science and Technology (AMIST), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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7
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Hori T, Ogawa K, Yamamoto H, Harada H, Matsumura K, Yamamoto M, Yamada M, Yazawa T, Kuriyama K, Tani M, Yasukawa D, Kamada Y, Aisu Y, Tani R, Aoyama R, Nakayama S, Sasaki Y, Nishimoto K, Zaima M. Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports. World J Clin Cases 2019; 7:2526-2535. [PMID: 31559288 PMCID: PMC6745316 DOI: 10.12998/wjcc.v7.i17.2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/10/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess. This refractory complication can be fatal; therefore, intensive treatment is important. Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis, and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL. We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.
CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and pancreatic leakage was observed postoperatively. Intractable pancreatic fistula led to intraperitoneal abscess, and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8. The abscess resolved after 7 d of CLL. The second patient underwent distal pancreatectomy. Pancreatic leakage was observed, and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump. CLL was instituted from POD 9, and the abscess resolved after 4 d of CLL. The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma. Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula; however, intraperitoneal abscess was detected on POD 59. We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult. CLL was instituted from POD 63, and the abscess resolved after 1 wk of CLL.
CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary Pancreatic and Breast Surgery, Ehime University, Toon 791-0295, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kazuyoshi Matsumura
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | | | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Katsutoshi Kuriyama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Shinnosuke Nakayama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Koki Nishimoto
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
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8
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Deprez P, Grand J, Harran N. Duodenal ganglioneuromatosis causing common bile duct obstruction in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Pauline Deprez
- Department of diagnostic imagingAquivet Clinique VeterinaireEysinesFrance
| | | | - Nathaniel Harran
- Department of diagnostic imagingAquivet Clinique VeterinaireEysinesFrance
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9
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Ajithkumar T, Taylor R, Kortmann RD. Radiotherapy in the Management of Paediatric Low-Grade Gliomas. Clin Oncol (R Coll Radiol) 2018; 31:151-161. [PMID: 30528521 DOI: 10.1016/j.clon.2018.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 12/18/2022]
Abstract
Paediatric low-grade (World Health Organization grade I-II) gliomas (LGGs) represent a spectrum of primary central nervous system tumours. Local tumour control is the cornerstone in the general management of childhood gliomas. Surgery is the primary treatment of choice in the majority. Non-surgical treatments are recommended for progressive or symptomatic inoperable disease. Although chemotherapy is increasingly used as first non-surgical treatment, radiotherapy remains standard as salvage treatment or as primary treatment in selected cases in which surrounding normal tissue can be optimally preserved. The role of targeted therapies is currently under investigation in clinical trials. Modern high-precision radiotherapy techniques, including proton therapy, have the potential to improve long-term toxicities. There is therefore an urgent need for prospective studies to compare the efficacy and safety of modern radiotherapy with systemic treatment in children with LGGs. New information on molecular genetic patterns in LGGs may also have an impact on the selection and sequencing of radiotherapy.
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Affiliation(s)
- T Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Trust, Cambridge, UK.
| | - R Taylor
- Department of Oncology, Swansea University and South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - R D Kortmann
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
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10
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Pan J, Ge X, Zhou W, Zhong X, Gu L, Zhu H, Li X, Qi W, Wang X. Comparison of clinical outcomes between mesh-reinforced pancreatojejunostomy and pancreatogastrostomy following pancreaticoduodenectomy: a cohort study. World J Surg Oncol 2018; 16:190. [PMID: 30223846 PMCID: PMC6142426 DOI: 10.1186/s12957-018-1491-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023] Open
Abstract
Background Postoperative complications, especially postoperative pancreatic fistulas, remain the major concern following pancreaticoduodenectomy (PD). Mesh-reinforced pancreatic anastomoses, including pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), are a new effective technique in PD. This study was conducted to analyze the safety and efficacy of this new technique and to compare the results of mesh-reinforced PJ vs PG. Methods A total of 110 patients who underwent PD between August 2005 and January 2016 were eligible in this study. Perioperative and postoperative data of patients with a mesh-reinforced technique were analyzed. Data were also grouped according to the procedure performed: mesh-reinforced PJ and mesh-reinforced PG. Results Among patients undergoing PD with the mesh-reinforced technique, 42 had postoperative complications, and the comprehensive complication index (CCI) was 32.7 ± 2.5. Only 10% of patients had pancreatic fistula; three were grade A, six were grade B, and two were grade C. Biliary fistula occurred in only 8.2% of patients. Patients undergoing mesh-reinforced PG showed a significantly lower rate of CCI than did mesh-reinforced PJ patients (27.0 ± 2.1 vs 37.0 ± 3.9, p < 0.05). The mesh-reinforced PG was also favored over mesh-reinforced PJ because of significant differences in intra-abdominal fluid collection (5.9% vs 18.6%, p < 0.05) and delayed gastric emptying (3.9% vs 15.3%, p < 0.05). Conclusions PD with the mesh-reinforced technique was a safe and effective method of decreasing postoperative pancreatic fistula. Compared with mesh-reinforced PJ, mesh-reinforced PG did not show significant differences in the rates of pancreatic fistula or biliary fistula. However, CCI, intra-abdominal fluid collection, and delayed gastric emptying were significantly reduced in patients with mesh-reinforced PG.
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Affiliation(s)
- Junhai Pan
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiaolong Ge
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Wei Zhou
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
| | - Xin Zhong
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Lihu Gu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Hepan Zhu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xinlong Li
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Weilin Qi
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xianfa Wang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Zizzo M, Ugoletti L, Morini A, Manenti A, Lococo F, Pedrazzoli C. Pancreaticojejunostomy with or without reinforcement after pancreaticoduodenectomy: surgical technique of ligamentum teres hepatis wrap around pancreaticojejunostomy. World J Surg Oncol 2018; 16:181. [PMID: 30193582 PMCID: PMC6129004 DOI: 10.1186/s12957-018-1484-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023] Open
Abstract
In a previous issue of the Journal, Zhong et al. reported a retrospective study that compared the perioperative outcomes of the mesh-reinforced pancreaticojejunostomy with conventional pancreaticojejunostomy. They concluded that mesh-reinforced pancreaticojejunostomy was a safe and effective technique, as it provided a safe anchor site for suture, thus reducing the risk of pancreatic leakage. Considering these encouraging results, we present a further simple technique using ligamentum teres hepatis wrap around pancreatojejunostomy for prevention of postoperative pancreatic fistula after pancreaticoduodenectomy.
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Affiliation(s)
- Maurizio Zizzo
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Lara Ugoletti
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Andrea Morini
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Antonio Manenti
- Department of General Surgery, University of Modena and Reggio Emilia - Polyclinic, 41124, Modena, Italy
| | - Filippo Lococo
- Department of Oncology and Advanced Technologies, Thoracic Surgery Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Claudio Pedrazzoli
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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