[Use of lanreotide in the prevention of pancreatic fistula after cephalic duodeno-pancreatectomy. Preliminary study]. / Usage du lanréotide dans la prévention des fistules pancréatiques après duodéno-pancréatectomie céphalique. Etude préliminaire.

STUDY AIM: Dehiscence of pancreatic anastomosis is the main complication after pancreatoduodenectomy. The efficacy of somatostatin analogue to prevent complications after pancreatic resections is at present well-established by several randomized trials. The aim of this preliminary prospective study was to assess the role of lanreotide (a long acting somatostatin analogue) in this field. PATIENTS AND METHOD: Forty patients with pancreatic head tumour have been included in a prospective study. Criteria for pancreatic fistula were: high concentration of amylase in the drainage fluid (> 3 times that in the serum), or intra-abdominal fluid collection adjacent to the pancreatic anastomosis, or reoperation (or postmortem verification) showing an anastomotic dehiscence. The patients received 12 h before the operation 30 mg of lanreotide intramuscularly. RESULTS: Of the 40 patients included prospectively, 34 underwent a pancreatic resection. Parenchyma of pancreatic remnant was crumbly in 28 cases. Six patients experienced a pancreatic fistula (17.6%) which healed in all cases. CONCLUSION: This preliminary study shows clearly the feasibility of a long acting somatostatin analogue (lanreotide) to prevent pancreatic fistula after pancreatectomy. This agent appears simple to use and its efficacy needs obviously to be assessed by randomized trials.

[Peroperative manometric evaluation of posterior fundoplication by celioscopy]. / Evaluation manométrique peropératoire des fundoplicatures postérieures par coelioscopie.

The aim of this prospective study was to evaluate objectively the effects of a laparoscopic posterior fundoplication on the pressure and length of the lower oesophageal sphincter (LOS) and to compare these results to those of a group of patient who underwent the same technique through a laparotomy. Fourty six patients were included in the laparoscopic group and 48 in the open group. Intraoperative manometry was performed using the same material before and after the posterior fundoplication (after evacuating the pneumoperitoneum). Criteria of assessment were the increases in pressure and length of the LOS. The two groups were comparable regarding age, rate of hiatal hernia, and stage of the oesophagitis. In the laparoscopic group, the mean pressure of LOS (mmHg) increased from 10.1 +/- 3.8 to 35.2 +/- 12 after the fundoplication (that is 3.5 times) and the length of LOS (cm) increased from 3.4 +/- 0.8 to 4.8 +/- 0.8 (that is 1.4 times). In the open group the increase was for the pressure and length respectively 3.3 times and 1.5 times the initial values. Thus by performing the same procedure we obtained the same effects on the pressure and length of the LOS. The effectiveness of laparoscopic posterior fundoplication should be similar to that of the open procedure.