ABSTRACT
The method of pancreaticojejunostomy in pancreaticoduodenectomy was applied in 20 patients. The technique is based on the first row of through P-shaped sutures in the sequence of jejunum-pancreas-jejunum. This method excludes thread pressure on pancreatic tissue. The technique may be used in any pancreatic texture. Pancreaticojejunostomy failure was observed in 2 patients (10%). The complication was not determined by pancreatic anastomotic technique in 1 case. There were 2 deaths (10%). The causes of lethal outcomes were not determined by peculiarities of pancreaticojejunostomy performing. The obtained results show good preventive properties of proposed method relatively pancreaticojejunostomy failure and postoperative pancreatitis.
Subject(s)
Anastomotic Leak , Intraoperative Care/methods , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Pancreaticojejunostomy , Surgical Wound Dehiscence , Sutures/adverse effects , Adult , Aged , Anastomotic Leak/epidemiology , Anastomotic Leak/etiology , Cause of Death , Female , Humans , Length of Stay , Male , Middle Aged , Pancreas/pathology , Pancreas/surgery , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/mortality , Pancreaticojejunostomy/adverse effects , Pancreaticojejunostomy/methods , Pancreaticojejunostomy/mortality , Russia , Surgical Wound Dehiscence/epidemiology , Surgical Wound Dehiscence/etiology , Survival Rate , Treatment OutcomeABSTRACT
The author offered an algorithm of definition of optimal ways of pancreaticodigestive fistula formation in pancreaticoduodenal resection. It is based on the following factors such as tissue conditions of the pancreas gland stump, a diameter of pancreatic duct and compliance with cut dimensions of gland stump of anastomotic loop of the jejunum. A comparative analysis of pancreaticodigestive fistulas performance was made in 2 groups. An algorithm of choice of pancreaticodigestive anastomosis was applied in the main group (n = 35). An inconsistency of pancreaticodigestive fistula was noted in the main group (5.7%) and in the comparative group (n = 59)--17% (p = 0.205). There weren't any cases of destructive pancreatitis and lethality, which were directly specified by pancreaticodigestive anastomosis in the main group. Destructive pacreatitis developed in 10.1% cases in the comparative group. The lethality consisted of 5.1%. The results obtained confirmed the efficacy of individualized approach to formation of pancreaticodigestive fistulas and showed the practical value of investigation in this way.
Subject(s)
Anastomotic Leak , Jejunum/surgery , Pancreas/surgery , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Pancreaticojejunostomy , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Anastomosis, Surgical/statistics & numerical data , Anastomotic Leak/etiology , Anastomotic Leak/prevention & control , Comparative Effectiveness Research , Female , Humans , Male , Middle Aged , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/mortality , Pancreaticojejunostomy/adverse effects , Pancreaticojejunostomy/methods , Russia , Survival Analysis , Treatment OutcomeABSTRACT
Treatment of 10 patients with bleedings from the pancreatic cysts was analyzed. Angiography with endovascular occlusion of the source of bleeding was used in 4 patients. Hemostasis was achieved in 2 patients. Emergency operations were made on 7 patients with continuing and repeated bleedings, and unsuccessful attempts of roentgen-endovascular treatment. Two patients after correction of anemia were subjected to planned operations according to the indications accepted for chronic cystic pancreatitis. The operation allows reliable liquidation of the source of bleeding and the symptoms of chonic pancreatitis.
