scholarly journals Evaluation of a New Modification of Pancreaticogastrostomy after Pancreaticoduodenectomy: Anastomosis of the Pancreatic Duct to the Gastric Mucosa with Invagination of the Pancreatic Remnant End into the Posterior Gastric Wall for Patients with Cancer Head of Pancreas and Periampullary Carcinoma in terms of Postoperative Pancreatic Fistula Formation

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Mohamed Mazloum Osman ◽  
Walid Abd El Maksoud
Keyword(s):  
Pancreatic Fistula ◽  
Gastric Wall ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Periampullary Cancer ◽  
Patients With Cancer ◽  
Pancreatic Remnant ◽  
Superficial Wound ◽  
Head Of The Pancreas ◽  
Posterior Gastric Wall

Background/Objectives. Postoperative pancreatic fistula (POPF) remains the main problem after pancreaticoduodenectomy and determines to a large extent the final outcome. We describe a new modification of pancreaticogastrostomy which combines duct to mucosa anastomosis with suturing the pancreatic capsule to posterior gastric wall and then invaginating the pancreatic remnant into the posterior gastric wall. This study was designed to assess the results of this new modification of pancreaticogastrostomy.Methods. The newly modified pancreaticogastrostomy was applied to 37 consecutive patients after pancreaticoduodenectomy for periampullary cancer (64.86%) or cancer head of the pancreas (35.14%). Eighteen patients (48.65%) had a soft pancreatic remnant, 13 patients (35.14%) had firm pancreatic remnant, and 6 patients (16.22%) had intermediate texture of pancreatic remnant. Rate of mortality, early postoperative complications, and hospital stay were also reported.Results. Operative mortality was zero and morbidity was 29.73%. Only three patients (8.11%) developed pancreatic leaks; they were treated conservatively. Eight patients (16.1%) had delayed gastric emptying, one patient (2.70%) had minor hemorrhage, one patient (2.70%) had biliary leak, and four patients (10.81%) had superficial wound infection.Conclusions. The new modified pancreatogastrostomy seems safe and reliable with low rate of POPF. However, further prospective controlled trials are essential to support these results.

scholarly journals Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy

HPB Surgery ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Fritz Klein ◽  
Igor Maximilian Sauer ◽  
Johann Pratschke ◽  
Marcus Bahra
Keyword(s):  
Bovine Serum Albumin ◽  
Serum Albumin ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Bovine Serum ◽  
Postoperative Mortality ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Pancreatic Remnant ◽  
The Impact

Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

scholarly journals Preoperative radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S178-S179
Author(s):  
E.W. Box ◽  
D.E. Morgan ◽  
L. Deng ◽  
R. Xie ◽  
J.K. Kirlin ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Radiographic Measurements

scholarly journals Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register-Based Study

2020 ◽  
Vol 44 (12) ◽  
pp. 4207-4213
Author(s):  
C. Williamsson ◽  
K. Stenvall ◽  
J. Wennerblom ◽  
R. Andersson ◽  
B. Andersson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Gain ◽  
Pancreatic Fistula ◽  
Predictive Factors ◽  
Biliary Drainage ◽  
National Registry ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Periampullary Cancer ◽  
High Bmi

Abstract Background A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. Methods Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. Results A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16–35] vs. 11 [8–15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001). Conclusion A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

Histomorphological Features of the Pancreatic Remnant as Independent Risk Factors for Postoperative Pancreatic Fistula: A Matched-Pairs Analysis

Pancreatology ◽  
2011 ◽  
Vol 11 (5) ◽  
pp. 516-524 ◽  
Author(s):  
Orlin Belyaev ◽  
Johanna Munding ◽  
Torsten Herzog ◽  
Dominique Suelberg ◽  
Andrea Tannapfel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Matched Pairs ◽  
Pancreatic Remnant ◽  
Independent Risk Factors

scholarly journals Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Amyna Jiwani ◽  
Tabish Chawla
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
Multivisceral Resection ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Fistula Formation ◽  
Factors Associated

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

scholarly journals Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

HPB ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 834-840 ◽  
Author(s):  
Jessica L. Mueller ◽  
David C. Chang ◽  
Carlos Fernandez-del Castillo ◽  
Cristina R. Ferrone ◽  
Andrew L. Warshaw ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation

scholarly journals A Simple and Safe Anastomosis for Pancreatogastrostomy Using One Binding Purse-String and Two Transfixing Mattress Sutures

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
D. K. Bartsch ◽  
P. Langer ◽  
V. Kanngießer ◽  
V. Fendrich ◽  
K. Dietzel
Keyword(s):  
Pancreatic Fistula ◽  
Gastric Wall ◽  
International Study ◽  
Modified Technique ◽  
Purse String ◽  
Reconstruction Procedure ◽  
Persistent Problem ◽  
Pancreatic Stump ◽  
Soft Pancreas ◽  
Posterior Gastric Wall

Pancreatic anastomotic leakage remains a persistent problem after pancreaticoduodenectomy (PD), especially in the presence of a soft, nonfibrotic pancreas. A modified technique for pancreatogastrostomy was devised, which combines one binding purse-string and two transfixing mattress sutures between the pancreatic stump and the posterior gastric wall. This technique was applied in 35 patients after PD for malignant and benign diseases of whom 10 (28.6%) had a soft pancreas. Median time for the anastomosis was 18 minutes. Operative mortality was zero, and morbidity was 34.3%. Three (8.6%) patients developed a pancreatic fistula (2 type A, 1 type B) as classified according to the International Study Group on pancreatic fistula. All fistulas resolved without further intervention. The described technique is a simple and safe reconstruction procedure after PD that warrants further evaluation.

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