scholarly journals “A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Roux on a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 223-227 ◽  
Author(s):  
Gianluigi Pescio ◽  
Erminio Cariati
Keyword(s):  
Pancreatic Fistula ◽  
Bile Ducts ◽  
Alimentary Tract ◽  
Jejunal Loop ◽  
Linear Stapler ◽  
Suggested Model ◽  
Biliary Anastomosis ◽  
Pancreaticojejunal Anastomosis ◽  
Enterogastric Reflux ◽  
Radionuclide Scanning

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to reconstitute the alimentary tract.The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear Stapler 3-4 centimeters from the biliary anastomosis. In this way, by employing the same loop without mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a stagnant cul-de-sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of leakage, a pure biliary and/or pancreatic fistula as far as is possible.99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction, showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any alkaline enterogastric reflux.

scholarly journals Step-by-step esophagojejunal anastomosis after intra-corporeal total gastrectomy for laparoscopic gastric cancer treatment: technique of "reverse anvil"

2014 ◽  
Vol 27 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Croider Franco LACERDA ◽  
Paulo Anderson BERTULUCCI ◽  
Antônio Talvane Torres de OLIVEIRA
Keyword(s):  
Total Gastrectomy ◽  
Circular Stapler ◽  
Jejunal Loop ◽  
Linear Stapler ◽  
Treatment Technique ◽  
Esophagojejunal Anastomosis ◽  
Technical Details ◽  
Gastric Cancer Treatment ◽  
Gastric Tubes ◽  
The Moment

Background: The laparoscopic gastrectomy is a relatively new procedure due mainly to the difficulties related to lymphadenectomy and reconstruction. Until the moment, technique or device to perform the esophagojejunal anastomosis by laparoscopy is still a challenge. So, a safe, cheap and quickly performing technique is desirable to be developed. Aim : To present technique proposed by the authors with its technical details on reconstruction with "reverse anvil". Method: After total gastrectomy completed intra-corporeally, the reconstruction starts with the preparation of the intra-abdominal esophagus cross-section next to the esophagogastric transition of 50%. A graduated device is prepared using Levine gastric tubes (nº. 14 and 10), 3 cm length, connected to the anvil of the circular stapler (nº. 25) with a wire thread (2-0 or 3-0) of 10 cm, which is connected to end of this device. The whole device is introduced in reverse esophagus. The esophagus is amputated and the wire is pulled after previous transfixation in the distal esophagus and the anvil positioned. The jejunal loop is sectioned 20-30 cm from duodenojejunal angle, and the anvil put in the jejunal loop and connect previously in the esophagus. Linear stapler (blue 60 mm) is used to close the opening of the jejunal loop. Conclusion: The "reverse anvil" technique used by the authors facilitated the transit reestablishment after total gastrectomy, contributing to obviate reconstruction problems after total gastrectomy.

Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Sanchez Bueno F ◽  
◽  
Gil Vazquez PJ ◽  
Ferreras D ◽  
Gomez B ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Randomized Study ◽  
Somatostatin Analogues ◽  
Postoperative Pancreatic Fistula ◽  
Initial Experience ◽  
Technical Success ◽  
Biodegradable Stent ◽  
Biodegradable Stents ◽  
Pancreatic Reconstruction ◽  
Pancreaticojejunal Anastomosis

Background: Postoperative Pancreatic Fistula (POPF) remains the most important morbidity after pancreaticoduodenectomy. There is no consensual technique for pancreatic reconstruction and many surgeons use a transanastomotic drain. Currently, the stents used are not degradable and they can cause obstruction, stricture and pancreatitis. The use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. The aim of the study was to evaluate technical success of implantation and safety of newly available biodegradable stents in 16 patients undergoing cephalic duodenopancreatectomy. Materials and Methods: A single-center prospective non-randomized study was conducted with patients undergoing PD. A total of 16 patients were included. A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum. Results: One of the patients developed POPF, which was successfully treated with interventional radiology drainage and somatostatin analogues. Completed degradation occurred after 3 months in all cases. There was no mortality at 30 days after PD. Conclusion: Based on our experience, the use of resorbable internal pancreatic prostheses could be a valid alternative to prevent POPF after a pancreaticoduodenectomy, also avoiding the main complications related to the use of non-absorbable prostheses.

Management of Complications from Hepatobiliary Surgery Using the Percutaneous Trans Jejunal Approach

1997 ◽  
Vol 83 (6) ◽  
pp. 912-917 ◽  
Author(s):  
Aldo Severini ◽  
Guido Cozzi ◽  
Monica Salvetti ◽  
Vincenzo Mazzaferro ◽  
Roberto Doci
Keyword(s):  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Tree ◽  
Jejunal Loop ◽  
Hepatobiliary Surgery ◽  
Management Of Complications ◽  
Therapeutic Procedures ◽  
Intrahepatic Lithiasis ◽  
Intravenous Cholangiography ◽  
Hepatobiliary Complications

Purpose The work was aimed at presenting the indications, techniques and results of the percutaneous transjejunal approach to the biliary tree in patients with hepatobiliary complications due to surgery. Patients and methods Ten patients, 7 males and 3 females, mean age 50 years (range, 10–62) with hepatico-jejunostomy, who developed cholangitis together with jaundice or bile leakage, underwent this procedure, performed through the anastomotic loop that was not surgically anchored to the abdominal wall in all cases but one. The transjejunal approach was chosen because of non-dilated bile ducts in 3 patients, complex pathologic situations in 5 patients and to avoid complications to a transplanted liver in 2 patients. The jejunal loop was identified using CT, US and fluoroscopy in 4 patients and after its opacification in the remaining 6 (by percutaneous transhepatic or intravenous cholangiography or fistulography). Results The procedure was technically and diagnostically successful in all cases. Therapeutic procedures (stenting, dilation, litholysis) were also performed using the transjejunal approach in 7 patients and in 6 of them complete pathological resolution was achieved. There were no complications. Conclusions Different pathologies of the biliary tree, in patients with bilio-enteric anastomoses, have been identified and treated by this technique; they were fistulas, anastomotic and/or multiple segmental benign or malignant stenoses of the bile duct, and diffuse intrahepatic lithiasis. The procedure was safe and reliable.

scholarly journals Is Roux-Y Binding Pancreaticojejunal Anastomosis Feasible for Patients Undergoing Left Pancreatectomy? Results from a Prospective Randomized Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Anne Antila ◽  
Juhani Sand ◽  
Isto Nordback ◽  
Sari Räty ◽  
Johanna Laukkarinen
Keyword(s):  
Portal Vein ◽  
Randomized Trial ◽  
Pancreatic Fistula ◽  
Group 13 ◽  
Pancreatic Remnant ◽  
Left Pancreatectomy ◽  
Clinically Significant ◽  
Pancreaticojejunal Anastomosis ◽  
To Receive ◽  
Closure Group

Background. After pancreaticoduodenectomy, the Finnish binding pancreaticojejunal anastomosis (FBPJ) seems to reduce the risk for pancreatic fistula (POPF). Our aim was to investigate whether FBPJ is feasible and prevents the risk for POPF even after left pancreatectomy (LP).Patients and Methods. 47 consecutive patients underwent LP. 27 patients were recruited on the basis of CT and, of these, 16 patients were randomized on the basis of findings during surgery (transection line must be left of portal vein, as 2-3 cm pancreatic mobilization is required for FBPJ) to receive either Roux-Y FBPJ or hand-sewn closure of the pancreatic remnant.Results. Only 34% (16/47) of the patients met the randomization criteria. Clinically significant POPF rate was higher in FBPJ group (60%) compared to thand-sewn closure group (13%;P<0.05). POPF rate in FBPJ group was higher even when compared to all patients with hand-sewn closure (60% versus 37%;P<0.05). Overall, FBPJ was technically feasible for only 28% of patients.Conclusion. FBPJ cannot be recommended for the routine closure of the pancreatic remnant after LP, as it was not technically achievable in 72% of the cases. Moreover, the technique does not seem to reduce the risk for POPF compared to the hand-sewn closure.

Prevention of pancreatic fistula by modified pancreaticojejunal anastomosis

1990 ◽  
Vol 160 (5) ◽  
pp. 533-534 ◽  
Author(s):  
Hope S. Maki ◽  
Robert L. Kolts ◽  
Marvin E. Kuehner
Keyword(s):  
Pancreatic Fistula ◽  
Pancreaticojejunal Anastomosis

scholarly journals Multiple bile ducts: do the duct distance and the number of biliary anastomosis have an impact on the recipient's biliary problems?

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e574
Author(s):  
K.C. Yoon ◽  
S.K. Hong ◽  
H.-S. Kim ◽  
H. Kim ◽  
N.-J. Yi ◽  
...  
Keyword(s):  
Bile Ducts ◽  
Biliary Anastomosis

scholarly journals Cephalic Duodeno-Pancreatectomy with Pancreatic-Gastric Anastomosis with Double Purse String, in Patient with Lithiasis and Tumoral Jaundice - Case Report

2014 ◽  
Vol 60 (5) ◽  
pp. 227-230
Author(s):  
A Tudor ◽  
C Molnar ◽  
C Nicolescu ◽  
C Rosca ◽  
Bianca Tudor ◽  
...  
Keyword(s):  
Case Report ◽  
Pancreatic Fistula ◽  
Bile Ducts ◽  
Epigastric Pain ◽  
Upper Endoscopy ◽  
Purse String ◽  
Pancreatic Parenchyma ◽  
Extrahepatic Bile Ducts ◽  
Wirsung Duct ◽  
Gastric Anastomosis

Abstract Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads. Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intraand extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable. Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

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