1
|
Chen G, Yin J, Chen Q, Wei J, Zhang K, Meng L, Lu Y, Wu P, Cai B, Lu Z, Miao Y, Jiang K. Selective use of pancreatic duct occlusion during pancreaticoduodenectomy in patients with a small-size duct and atrophic parenchyma in the distal pancreas: A retrospective study. Front Surg 2023; 9:968897. [PMID: 36684200 PMCID: PMC9852517 DOI: 10.3389/fsurg.2022.968897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background Despite the advancements in surgical techniques, postoperative pancreatic fistula (POPF) remains a potentially life-threatening complication of pancreaticoduodenectomy (PD). Pancreatic duct occlusion (PDO) without anastomosis has also been proposed to alleviate the clinical consequences of POPF in selected patients after PD. Objectives To assess the safety and effectiveness of PDO with mechanical closure after PD in patients with an atrophic pancreatic body-tail and a small pancreatic duct. Methods We retrospectively identified two female and two male patients from April 2019 to October 2020 through preoperative computed tomography of the abdomen. Among them, three patients underwent PDO with mechanical closure after PD, and one underwent PDO after pylorus-preserving PD. In addition, patients' medical records and medium-and long-term follow-up data were analyzed. Results Postoperative histological examination revealed a solid pseudopapillary tumor in two patients, pancreatic ductal adenocarcinoma in one patient, and chronic pancreatitis with pancreatic duct stones in one patient. However, none of the patients developed biochemical or clinically relevant POPF, with no postpancreatectomy hemorrhage, biliary leakage, delayed gastric emptying, intra-abdominal abscess, or chyle leakage. Among the four patients, three developed new-onset diabetes mellitus, and one had impaired glucose tolerance. Furthermore, three patients received pancreatic enzyme supplementation at a dose of 90,000 Ph. Eur. units/d, and one was prescribed a higher dose of 120,000 Ph. Eur. units/d. Conclusions PDO with mechanical closure is an alternative approach for patients with an atrophic pancreatic body-tail and a small pancreatic duct after PD. Therefore, further evidence should evaluate the potential benefits of selective PDO in these patients.
Collapse
Affiliation(s)
- Guangbin Chen
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China,Department of Hepatobiliary Surgery, Wuhu Hospital Affiliated to East China Normal University, Wuhu, China
| | - Jie Yin
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Qun Chen
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Jishu Wei
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Lingdong Meng
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Yichao Lu
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Pengfei Wu
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Baobao Cai
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Zipeng Lu
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China,Correspondence: Kuirong Jiang Zipeng Lu
| | - Yi Miao
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China,Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Kuirong Jiang
- Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Pancreas Institute, Nanjing Medical University, Nanjing, China,Correspondence: Kuirong Jiang Zipeng Lu
| |
Collapse
|
2
|
Mehrabi A, Abbasi Dezfouli S, Schlösser F, Ramouz A, Khajeh E, Ali-Hasan-Al-Saegh S, Loos M, Strobel O, Müller-Stich B, Berchtold C, Mieth M, Klauss M, Chang DH, Wielpütz MO, Büchler MW, Hackert T. Validation of the ISGLS classification of bile leakage after pancreatic surgery: A rare but severe complication. Eur J Surg Oncol 2022; 48:2440-2447. [PMID: 35842371 DOI: 10.1016/j.ejso.2022.06.030] [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] [Received: 05/01/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Hepaticoenterostomy is an important step of reconstruction during hepatopancreatobiliary (HPB) surgery with a subsequent bile leakage rate of up to 5%. The International Study Group of Liver Surgery (ISGLS) proposed a severity grading system for defining bile leakage after HPB surgery, which has not been validated after pancreatic surgery in a large patient cohort. The present study aimed to validate the ISGLS definition for bile leakage in pancreatic surgery and to investigate the postoperative outcomes of bile leakage after pancreatic resections. MATERIALS AND METHODS Data from the prospectively maintained database for pancreas surgery were extracted for any type of pancreatectomy with hepaticoenterostomy between 2006 and 2019. The severity of bile leakage was graded according to the ISGLS definition. The influence of our standardized hepaticoenterostomy technique and of the complexity of the surgical procedure on the rate of clinically relevant bile leakages (B and C) were assessed in three different timeframes. RESULTS Bile leakage was detected in 152 of 5,300 patients (2.9%). Clinically relevant bile leakages included seventy patients with grade B and eighty-two patients with grade C bile leakages (46.1% and 53.9%, respectively). During the study period, the overall rate of bile leakage showed to be stable (from 3.5% to 2.4%). Patients with grade C bile leakage had a higher rate of postoperative wound infection (P < 0.001) and longer ICU stays and hospital stays compared to patients with grade B bile leakage (P = 0.03 and P < 0.001 respectively). These parameters were significantly higher in patients with late grade C bile leakage but were similar between patients with grade B bile leakage and early grade C bile leakage (<5th day POD). In the whole patients' cohort, the 90-day mortality rate was 3.2% (174/5,300), with a rate of 25% in patients with bile leakage (38/152). CONCLUSION The ISGLS classification is a valid method for classifying postoperative bile leak after pancreas surgery. Standardization of our hepaticoenterostomy technique resulted in a stable rate of bile leakage. Although rare, bile leakage following pancreas surgery is a severe complication that has a major impact on patient outcomes and contributes significantly to morbidity and mortality, even in the absence of POPF.
Collapse
Affiliation(s)
- Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany.
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Fabian Schlösser
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Martin Loos
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Christoph Berchtold
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Miriam Klauss
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - De-Hua Chang
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Mark O Wielpütz
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| |
Collapse
|