Preliminary results of binding pancreaticojejunostomy

BACKGROUNDS/AIMS: The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng. METHODS: We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines. RESULTS: Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management. CONCLUSIONS: The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

Measurement of Length between Bronchial Carina and Superior Vena Cava-right Atrial Junction for Optimal Positioning of Central Venous Catheters in the Korean Adult Population / 대한혈관외과학회지

PURPOSE: Bronchial carina (BC) is one of the landmarks often used during central venous catheter (CVC) insertion. The aim of this study is to measure the superior vena cava (SVC) length and the length between the BC and the SVC-right atrial junction (LBCSAJ), using chest computed tomography (CT) scans in the Korean adult population, and to review the optimal location for the catheter tip, during CVC access using BC. METHODS: The study subjects were 238 consecutive subjects who underwent a chest CT scan with contrast and 5 mm thickness, in Inha University Hospital, between January 2010 and December 2011. Subjects who had any lung disease were excluded before enrollment. The subjects' clinical characteristics and imaging data were reviewed. The SVC length and LBCSAJ was measured at a 3-dimension workstation (Osirix). RESULTS: The mean age was 56.69+/-4.83 years, mean body weight 61.09+/-11.12 kg, height 161.72+/-9.15 cm, and body mass index (BMI) was 23.07+/-4.45 kg/m2. The mean length of the SVC was 47.67+/-10.92 mm, and the mean LBCSAJ was 30.80+/-9.03 mm. Men have a longer SVC and LBCSAJ than women (52.80+/-10.59 vs. 42.96+/-8.72, P=0.000). The age and height were significant covariates of the SVC length and the LBCSAJ. BMI was a significant covariate of the LBCSAJ in multivariate analysis. CONCLUSION: An understanding of anatomy and the actual length of the SVC in relation to bronchial carina is important for proper placement of a central venous catheter. This study gives its basic characteristics in the Korean adult population.