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Distal pancreatectomy is the first choice for the treatment of benign, malignant, inflammatory and traumatic lesions in the body and tail of pancreas. In recent decades, abdominal drainage has been a common therapeutic option to reduce postoperative complications in abdominal surgery. However, with the rise of the theory of accelerated rehabilitation surgery, the safety and effectiveness of postoperative abdominal drainage have been controversial, and the placement and management of intraoperative drainage have been questioned. This article reviewed the related literatures at home and abroad, and summarized the controversial issues such as whether to place abdominal drainage tube after distal pancreatectomy, the choice of postoperative drainage mode, and the timing and indication of abdominal drainage tube removal.
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Objective@#To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR).@*Methods@#The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People’s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed.@*Results@#The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525.8±121.8) minutes, and the blood loss (250.0±191.5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well.@*Conclusions@#LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection ( LDPPHR ) . Methods The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People' s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed. Results The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525. 8 ± 121. 8) minutes, and the blood loss (250. 0 ± 191. 5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well. Conclusions LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.There were 26 males and 13 females,aged (60±7)years,with a range of 41-75 years.All the 39 patients underwent PD,using Child method to reconstruct digestive tract.Of 39 patients,19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group,respectively.Observation indicators:(1)surgical situations;(2) postoperative complications;(3) follow-up.Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence,main pancreatic duct dilatation,survival,and discomfort (abdominal pain,bloating,indigestion,etc.) of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as M (P25,P75) or M (range),and comparison between groups was analyzed by Mann Whitney U test.Count data were expressed as absolute numbers,and comparison between groups was analyzed by chi-square test or Fisher exact probability.Results (1) Surgical situations:operation time,volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay of the innovative group were (342±47) minutes,400 mL (300 mL,400 mL),10,9,3.1 cm (2.9 cm,3.4 cm),37 days (32 days,63 days),17,18 days (15 days,22 days),respectively,versus (392±95)minutes,400 mL (300 mL,525 mL),6,14,3.6 cm (2.6 cm,4.2 cm),43 days (34 days,49 days),18,and 24 days (15 days,27days) of the traditional group;there was no significant difference in the volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay between the two groups (Z=-0.775,x2 =2.063,Z=-1.155,Z=-0.295,x2 =0.003,Z=-1.286,P＞0.05);but a significant difference in operation time between the two groups (t =-2.114,P＜0.05).(2) Postoperative complications:6 patients in the innovative group had complications,including 1 of delayed gastric emptying,1 of wound infection,1 of pulmonary infection,1 of acute respiratory failure,1 of perihepatic effusion,and 3 of grade A pancreatic leakage;11 patients in the traditional group had postoperative complications,including 1 of bile leakage,2 of delayed gastric emptying,4 of abdominal infection,4 of wound infection,2 of pulmonary infection,1 of ascites,1 of abdominal hemorrhage,1 of pleural effusion,2 of grade A pancreatic leakage,5 of grade B and C pancreatic leakage;the same patient had multiple complications.There was no significant difference in postoperative complications between the two groups (x2=2.174,P＞0.05),but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P＜O.05).Patients with postoperative complications were improved after symptomatic support treatment,and no patient died during the perioperative period.(3) Follow-up:of the 39 patients,33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months,with a median follow-up time of 17 months.Of the 18 patients receiving follow-up in the innovative group,5 died of tumor recurrence and metastasis,with a survival time of 5-24 months,1 had tumor recurrence at 34 months after operation,1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,5 had indigestion,1 had back pain,and 5 had good recovery.Of 15 patients receiving follow-up in the traditional group,10 died of tumor recurrence and metastasis,with a survival time of 3-57 months,2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,2 had indigestion,1 had good recovery.Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy,modified invagination for pancreaticojejunostomy in the PD is safe and feasible,which can simplify the operation,reduce the requirements for the operator's operation skills,shorten the operation time,and reduce incidence of postoperative grade B and C pancreatic leakage.
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Objective To investigate the safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD). Methods Clinical data of 9 patients who underwent LPD operation from September 2014 to February 2017 in the first hospital of Shanxi Medical University were analyzed retrospectively. Results 9 patients attempted LPD, while one required conversation to open procedure. Two cases underwent hand assisted laparoscopic surgery .The average operative time was (553 ± 86.1) minutes, the average amount of bleeding was (333.3 ± 304.1) ml, and the average hospitalization time after operation was (25.3 ± 8.9) d. Postoperative bowel sound recovery time was (3.5 ± 1) d. Postoperative complications included pancreatic leakage in 4 cases (A grade pancreatic leakage in 1 cases, B grade in 3 case), lymph leakage in 1 case, abdominal hemorrhage in 1 case , gastric emptying in 2 cases , and bile leakage in 1 case. All patients with postoperative complications were cured by non operative treatment. Postoperative pathological examination showed that 5 cases had duodenal papillary adenocarcinoma, 1 case had pancreatic ductal carcinoma, 2 cases had common bile duct disruption differentiation of carcinoma, and 1 case had pancreatic head retention cyst. Patients were followed up 3 to 24 months after operation. 1 case of pancreatic duct died 17 months after operation. One case of middle bile duct carcinoma 12 months after surgery had liver and retroperitoneal lymph node metastasis. The remaining 7 cases had no complications. Conclusions laparoscopic pancreaticoduodenectomy is minimally invasive, safe and feasible.
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Objective To investigate the nursing points of pancreatic leakage after upper abdominal multiple organ transplantation. Methods A retrospective study was conducted on the nursing experience of two patients with end-stage liver disease and type 2 diabetes mellitus who were complicated with pancreatic leakage after upper abdominal multiple organ transplantation from March 2009 to July 2015. Results The blood glucose of these patients returned to normal level within 1 week after operation and insulin was discontinued. Pancreatic leakage was occurred in the two patients at 14 and 21 days after operation, respectively. They were both successfully discharged after active treatments and nursing cares including completely drainage, the application of drugs that inhibited the secretion of pancreatic enzymes and digestive tract glands, strengthening infection control, nutritional support and other conservative treatments. Conclusions It is the key to improve the recovery of pancreatic leakage after upper abdominal multiple organ transplantation with careful observation of abdominal signs and abdominal drainage tube, accurate use of somatostatin, nutritional support, maintenance of water and electrolyte balance, and psychological intervention.
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Objective To investigate the risk factors and management of delayed hemorrhage after pancreatoduodenectomy.Methods A retrospective analysis of delayed hemorrhage after the pancreatoduodenectomy in 136 patients was performed.Results In 136 patients,delayed hemorrhage occurred in 19 cases,and the incidence rate was 14.0％ (19/136).10 cases was severe hemorrhage,and sentinel bleeding occurred in 6 cases,also 5 died due to the intra-abdominal infection and MODS.Conclusion Delayed hemorrhage after the pancreatoduodenectomy is closely related to pseudoaneurysm,bleeding due to arteriorrhexis,bleeding of the pancreas' stump.Meanwhile abdominal infection and MODS may be the main reason of the patients' death.Pre-operative preparation,best operation skills and proper post-operation management are the key points to the prevention and treatment of delayed hemorrhage.
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Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.
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Objective To investigate the efficacy of wrapping and suturing of pancreatic stump with the avascular zone of the transverse mesocolon for preventing pancreatic leakage after distal pancreatectomy.Methods The clinical data of 69 patients who received distal pancreatectomy at the Affiliated Tumor Hospital of Zhengzhou University from May 2011 to March 2014 were retrospectively analyzed.The pancreatic stump was wrapped with the avascular zone of the transverse mesocolon after suturing the pancreatic stump in 34 patients (the modified group),and the pancreatic stump of 34 patients was sutured without any other treatment (the control group).The time for pancreatic stump management,complications,time for drainage tube placement and duration of postoperative hospital stay of the 2 groups were compared.Patients were followed-up through outpatient examination and telephone interview till June 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results The time for pancreatic stump management of the modified group and the control group were (15.2 ± 2.1) minutes and (13.2 ± 3.2) minutes,with no significant difference between the 2 groups (t =1.565,P ＞ 0.05).No patient was complicated with other diseases in the modified group,while 9 patients in the control group was complicated with pancreatic fistula,with significant differences between the 2 groups (x2=9.399,P ＜0.05).The time for drainage tube placement of the modified group and the control group were (6.1 ± 2.2) days and (16.6 ± 3.5) days,the duration of postoperative hospital stay were (12.5 ± 2.5) days and (21.5 ± 3.5) days,with significant difference between the 2 groups (t =-11.902,-9.853,P ＜ 0.05).Sixty-three patients were followed up from 1 to 35 months with a mean time of 15 months.Fifteen patients died,and the condition of other patients was normal.Conclusion Wrapping and suturing of the pancreatic stump with the avascular zone of the transverse mesocolon is effective for preventing the pancreatic leakage after distal pancreatectomy and shortens the time of postoperative hospital stay.
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Pancreatic leakage is most common among numerous complications after pancreaticoduodenectomy surgery.Predicting at early stage and taking preventive measures in time are of great importance to reducing the incidence of pancreatic leakage as well as its related complications.The article reviewed pancreatic leakage monitoring related reports worldwide in recent 10 years.It was found that some factors were useful for the prediction of pancreatic leakage including the drainage fluid amylase and leukocyte count on postoperative day 1 and 3,C-reactive protein on postoperative day 3,the combined detection of white blood cells and albumin on postoperative day 4,the serum urea nitrogen and the serum albumin on postoperative day 1 and 5-8 days,as well as the ratio of amylase level in abdominal drainage to abdominal drainage volume.
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Objective To summarize the results of a new pancreaticojejunostomy technique designed to decrease incidence of pancreatic leakage in pancreatoduodenectomy.Methods The clinical data of 11 cases of pancreatoduodenectomy using remnant pancreatico-jejunum end-to-end anastomosis with external drainage of full pancreatic juice was analyzed retrospectively.Briefly,5-0 bioabsorbable suture was penetrated through the pancreatic stump and stent and then circulated the pancreatic stump for 2 circles and ligated.Octreotide was not administered in any cases post-operation.Results The operation was simple and timespared.Neither pancreatic leakage nor postoperative bleeding occurred in the cases.From 4 months to 3 years following operation,no other complications were found in all cases.Conclusions The method was safe,feasible and effective to decrease incidence of pancreatic leakage in pancreatoduodenectomy.
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Objective To investigate the complications and the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 339 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to Decembcr 2009 were retrospectively analyzed.The risk factors of pancreatic fistula were analyzed.The incidences of complications accured from 2000 to 2004 and from 2005 to 2009 were compared.All data were analyzed by the t test,chi-square test,Fisher exact probability or Logistic regression model.Results The incidence of complications of all patients was 33.0％ ( 112/339),and the incidence of pancreatic fistula was 8.6％ (29/339).Of the 29 patients complicated with pancreatic fistula,6 patients were in grade A,8 in grade B and 15 in grade C.Soft texture of remnant pancreas and the diameter of pancreatic duct smaller than 3 mm were the independent risk factors of pancreatic fistula( OR =1.75,3.75,P ＜ 0.05 ).The number of hospital death was 12,including 1 patient died during the first period (2000-2004) and 11 patients died during the second period (2005-2009).Three patients died of pancreatic fistula and abdominal hemorrhage,3 died of postoperative upper gastrointesitnal bleeding,2 died of cardiac insufficiency,1 died of respiratory failure,1 died of pancreatic fistula,abdominal infection and necrotic pancreatitis,1 died of abdominal hemorrhage and hepatic and renal failure,1 died of bililary fistula,abdominal infection and multiple organ dysfunction syndrome.Conclusions Soft texture of remnant pancreas and the diameter of the pancreatic duct smaller than 3 mm are important risk factors of postoperative pancreatic fistula.Pancreatic fistula is the main factor causing death after pancreaticoduodenectomy.
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Objective To investigate the safety and feasibility of a new pancreaticojejunal anastomotic method [the penetrating-suture type of pancreaticojejunostomy (PPJ)] after pancreaticoduodenectomy (PD).Methods From May 2005 to November 2011,a new surgical anastomosis was carriedout between the pancreas stump and jejunal wall with penetrating-suture technique after pancreaticoduodenectomy in 46 patients.The clinical data were reviewed and analysed.Results The anastomosis of the pancreas stump and jejunal wall was completed with six to eight interrupted full-layer sutures.There was no pancreatic anastomotic leakage and hemorrhage.Conclusion The PPJ is a simple and effective approach and can be recommended.
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PURPOSE: Pancreatic leakage is a serious complication of gastrectomy due to stomach cancer. Therefore, we analyzed amylase and lipase concentrations in blood and drainage fluid, and evaluated the volume of drainage fluid to discern their usefulness as markers for the early detection of serious pancreatic leakage requiring reoperation after gastrectomy. METHODS: From January 2001 to December 2007, we retrospectively analyzed data from 24,072 patient samples. We divided patients into two groups; 1) complications with pancreatic leakage (CG), and 2) no complications associated with pancreatic leakage (NCG). Values of amylase and lipase in the blood and drainage fluid, volume of the drainage fluid, and relationships among the volumes, amylase values, and lipase values in the drainage fluid were evaluated, respectively in the two groups. RESULTS: The mean amylase values of CG were significantly higher than those of NCG in blood and drainage fluid (P < 0.05). For lipase, statistically significant differences were observed in drainage fluid (P < 0.05). The mean volume (standard deviation) of the drained fluid through the tube between CG (n = 22) and NCG (n = 236) on postoperative day 1 were 368.41 (266.25) and 299.26 (300.28), respectively. There were no statistically significant differences between the groups (P = 0.298). There was a correlation between the amylase and lipase values in the drainage fluid (r = 0.812, P = 0.000). CONCLUSION: Among postoperative amylase and lipase values in blood and drainage fluid, and the volume of drainage fluid, the amylase in drainage fluid was better differentiated between CG and NCG than other markers. The volume of the drainage fluid did not differ significantly between groups.
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Humans , Amylases , Drainage , Gastrectomy , Lipase , Reoperation , Retrospective Studies , Stomach NeoplasmsABSTRACT
Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.
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PURPOSE: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. RESULTS: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn't show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22(12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. CONCLUSION: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula.
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Humans , Diagnosis , Incidence , Pancreatic Ducts , Pancreatic Fistula , Pancreaticoduodenectomy , Pancreaticojejunostomy , Pancreatitis , Retrospective Studies , Risk Factors , Stomach NeoplasmsABSTRACT
Pancreaticogastrostomy (PG) has been used as an alternative procedure for pancreaticojejunostomy (PJ) for reconstruction after a pancreaticoduodenectomy (PD). Leakage at the pancreatoenteric anastomosis is still a major cause of morbidity and mortality after a PD. Therefore the major goal of technical modifications should be elimination or at least a reduction of pancreatic leakage. A number of published studies have shown that PG is associated with a low rate of anastomotic leakage. PG is easier to perform due to the thick posterior wall of the stomach and its excellent blood supply being proximal to the remaining pancreas. Furthermore, the pancreatic juice appears to be neutralized by the gastric juice, resulting in a reduction in the morbidity and mortality associated with anastomotic leakage. PG also results in a straight alignment of the digestive tract without an A-loop. PG and PJ showed an impaired exocrine and endocrine pancreatic function with a similar extent. The activity of the pancreatic enzymes is inhibited in the stomach after a PG. The enzymes become activated when gastric pH exceeds 3.1, which normally occurs after the ingestion of a meal. In conclusion, we recommend duct-to-mucosa PG as a beneficial alternative to a PJ, even in the hands of an inexperienced surgeon.
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Anastomotic Leak , Eating , Gastric Juice , Gastrointestinal Tract , Hand , Hydrogen-Ion Concentration , Meals , Mortality , Pancreas , Pancreatic Juice , Pancreaticoduodenectomy , Pancreaticojejunostomy , StomachABSTRACT
We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital.
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PancreaticoduodenectomyABSTRACT
Objective To investigate the effect of binding pancreaticojejunostomy (BPJ) on the prevention of the pancreatic leakage after pancreaticoduodenectomy(PD). Methods The clinical data of 108 patients who underwent PD, including 26 cases of BPJ since 2001 and 82 cases of other type of pancreaticojejunostomy from 1993 to 2000,were retrospectively analyzed. Results The frequency of pancreatic leakage in this series was 13.9%. No pancreatic leakage occurred in BPJ group, whereas the frequency of pancreatic leakage in end-to-end invaginated pancreaticojejunostomy group and duct-to-mucosa pancreaticojejunostomy group was 24.6%(14/57) and 4.0%(1/25),respectively. The frequency of pancreatic leakage in BPJ group was significantly lower than that in end-to-end invaginated pancreaticojejunostomy group(P0.05). Conclusion BPJ may be effective in the prevention of the pancreatic leakage after PD.