ABSTRACT
Objective@#To evaluate the significance of double pancreatico-jejunostomy in preventing pancreatic fistula after central pancreatectomy (CP) .@*Methods@#The clinical data of 10 patients who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from Feb. 2012 to Dec. 2018 were analyzed retrospectively.@*Results@#All the 10 patients underwent CP, closure of the proximal pancreatic stump, and end-to-side invaginated pancreaticojejunostomy; At the same time, invaginated pancreaticojejunal anastomosis or duct-to-mucosa pancreaticojejunostomy was performed to the distal pancreatic remnant. The duration of the operation was (240±60) min, and the average intraoperative blood loss was 300 ml. Incidence of pancreatic fistulas was 30% (3/10) . There were no grade B or C pancreatic fistulas, or perioperative deaths. The duration of postoperative hospital stay varied from 9 to 25 days. Endocrine and exocrine functions were well maintained during the follow-ups of 7 months to 5 years, and no tumors recurred.@*Conclusions@#Although operation time and technical difficulty increase, central pancreatectomy using double pancreaticojejunostomy is safe, feasible, and appears to be associated with a low rate of postoperative pancreatic fistulas.
ABSTRACT
Objective To evaluate the significance of double pancreatico-jejunostomy in preventing pan-creatic fistula after central pancreatectomy (CP). Methods The clinical data of 10 patients who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from Feb. 2012 to Dec. 2018 were analyzed retro-spectively. Results All the 10 patients underwent CP, closure of the proximal pancreatic stump, and end-to-side invaginated pancreaticojejunostomy; At the same time, invaginated pancreaticojejunal anastomosis or duct-to-mu-cosa pancreaticojejunostomy was performed to the distal pancreatic remnant. The duration of the operation was (240±60) min, and the average intraoperative blood loss was 300 ml. Incidence of pancreatic fistulas was 30％(3/10). There were no grade B or C pancreatic fistulas, or perioperative deaths. The duration of postoperative hospital stay varied from 9 to 25 days. Endocrine and exocrine functions were well maintained during the follow-ups of 7 months to 5 years, and no tumors recurred. Conclusions Although operation time and technical diffi-culty increase, central pancreatectomy using double pancreaticojejunostomy is safe, feasible, and appears to be as-sociated with a low rate of postoperative pancreatic fistulas.
ABSTRACT
Objective To assess the effects of applying pancreaticogastrostomy and pancreaticojejunostomy in central pancreatectomy on postoperative outcome and short-term complications. Methods The clinical data of 25 patients who received central pancreatectomy from May 2013 to May 2015 were retrospectively analyzed. The reconstruction methods were pancreaticogastrostomy or pancreaticojejunostomy, and the pancreatic duct were anastomosed with stomach or intestinal mucosa lips openings by magnetic induction line suture. Then the postoperative pancreatic fistula and hospital stay were compared between the two groups. Results The baseline data of two groups were comparable, and there were no significant differences in postoperative pancreatic fistula rates or hospital stay between the two groups. The 25 patients did not have anastomotic bleeding. Two cases with proximal pancreatic stump fistula were observed and were cured by adequate drainage, octreotide acetate injection, parenteral nutrition and so on. Conclusion Central pancreatectomy can better maintain the pancreas function. pancreaticogastrostomy and pancreaticojejunostomy are both safe.
ABSTRACT
PURPOSE: Laparoscopic single site surgery is currently available, but may not be feasible for delicate and complex surgical procedures. However, computer technology embedded into robotic surgical system could provide the way to advanced laparoscopic single site surgery. METHODS: 86-year-old, female cadaver who died from sepsis was used for testing technical feasibility of robotic single site surgical system (the da Vinci Surgical System_(Intuitive Surgical, Sunnyvale, CA)) in performing central pancreatectomy. RESULTS: About 4 cm×3 cm×1.5 cm sized segment of pancreatic neck portion was resected. Distal remnant pancreas was managed by two-layered, duct-to-mucosa pancreaticojejunostomy by intracorporeal suture technique. Operative procedure was completed in 150 min. CONCLUSION: Robotic single site central pancreatectomy with pancreaticojejunostomy was technically feasible in the present cadaveric experiment.
Subject(s)
Aged, 80 and over , Female , Humans , Cadaver , Neck , Pancreas , Pancreatectomy , Pancreaticojejunostomy , Sepsis , Surgical Procedures, Operative , Suture TechniquesABSTRACT
The conventional techniques of pancreatic resections, most of the time imply in the withdrawal of ex-tensive segments of pancreatic parenchyma, having as possible complications at the long time, the appearance of endocrine or exocrine insufficience. The central pancreatectomy consists in an alternative of pancreatic resection to resect benign or low grade malignant tumours located in the pancreatic isthmus. We present the clinical characteristics, image, and the surgical technique used, for withdraw of pancreatic isthmus nonfunctioning pancreatic neuroendocrine neoplasm and pancreatic serous cystic adenoma.
Las técnicas convencionales de resección pancreática para el tratamiento de enfermedades neoplásicas, en la mayoría de las veces implican la extirpación de segmentos extensos del parénquima pancreático, existiendo como eventuales complicaciones a largo plazo, el surgimiento de insuficiencia pancreática endocrina o exocrina. La pancreatectomía central se constituye en una alternativa de resección pancreática, que limita esta resección solamente al sector comprometido, especialmente en las neoplasias benignas o de bajo grado de malignidad. Presentamos las características clínicas, de imagen y la técnica empleada en dos pacientes, para el tratamiento quirúrgico de un tumor endocrino no funcionante y de un cistoadenoma seroso, localizados en el cuello del páncreas, mediante la pancreatectomía central.
Subject(s)
Humans , Female , Adult , Middle Aged , Carcinoma, Neuroendocrine/surgery , Cystadenoma, Serous/surgery , Pancreatic Neoplasms/surgery , Pancreatectomy/methods , Carcinoma, Neuroendocrine/diagnosis , Cystadenoma, Serous/diagnosis , Immunohistochemistry , Pancreatic Neoplasms/diagnosisABSTRACT
PURPOSE: Pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) are treatments used for pancreatic benign neoplasms even though both of these treatments result in significant loss of normal pancreatic parenchyma; this leads to subsequent impairment of exocrine and endocrine pancreatic function. The purpose of this study is to provide short-and long-term result of limited resection (LR) in a single center. METHODS: Two-hundred thirty patients who had undergone pancreatic resection between April 1998 and September 2008 for benign neoplasms were reviewed retrospectively. DP was performed in 102 patients, LR in 77, PD in 51 patients. The definitions of the International Study Group of Pancreatic Fistula (ISGPF) were applied to postoperative pancreatic fistulas (POPF), perioperative endocrine function was evaluated through oral glucose tolerance test. RESULTS: LR includes 42 enucleation, 24 central pancreatectomy, and 11 uncinate process resection. No deaths occurred to patients during the study review period; POPF was detected in 50 patients (65%), 37 patients with grade A and 13 patients with grade B or C. POPF occurred 65% of the time after LR, more frequently compared to the occurrance after PD or DP (58%), but this was not statistically significant (P =.322). After LR, there were 2 patients with new onset diabetes (3%), while 26 (17%) patients developed diabetes after DP or PD (P = .002). CONCLUSION: LR may preserve endocrine and exocrine function. While mortality is low with the use of LR, it is associated with a higher pancreatic-leakage rate. The precise management of benign pancreatic lesions remains in evolution.