scholarly journals Innovations in pancreatic anastomosis technique during pancreatoduodenectomies

2020 ◽  
Vol 405 (7) ◽  
pp. 1039-1044
Author(s):  
S. Ferencz ◽  
Zs. Bíró ◽  
A. Vereczkei ◽  
D. Kelemen
Keyword(s):  
Pancreatic Fistula ◽  
Reoperation Rate ◽  
Whipple Procedure ◽  
Morbidity Rate ◽  
Amylase Level ◽  
Pancreatic Anastomosis ◽  
Drain Removal ◽  
Pancreatic Resections ◽  
Drain Amylase

Abstract Purpose Pancreatic fistula following pancreatic resections is still a relevant complication. The present work shows the efforts of a single institute to decrease this problem. Methods A total of 130 patients (63 men, 67 women) with a mean age of 60 (range: 23–81) years were operated on between January 2013 and March 2020. The most frequent type of pancreatic resection was a Whipple procedure with partial antrectomy. During all operations, an innovative method was used, namely a modification of the purse-string suture pancreatojejunostomy. Moreover, an early drain removal policy was applied, based on the drain amylase level on the first and subsequent postoperative days. Results Mean postoperative hospital stay was 13 days (range: 7–75). The overall morbidity rate was 43.8%; the clinically relevant (grade B/C) pancreatic fistula (CR-POPF) rate was 6.9%. Delayed gastric emptying (DGE) was observed in 4% of the patients. The ratio of operative mortality was 0.7%; the reoperation rate was 5.3%. Based on the drain amylase level on the first postoperative day, two groups could be established. In the first one, the drain was removed early, on the fourth day in average (range: 2–6). In the other group, the drain was left in situ protractedly or reinserted later on. Conclusion A single center’s experience proves that the refinement of the technique can improve the results of pancreatic surgery.

Evaluation of Drain Amylase Level after Pancreaticoduodenectomy with Special Reference to Delayed Pancreatic Fistula

2018 ◽  
Vol 84 (3) ◽  
pp. 403-409
Author(s):  
Takashi Maeda ◽  
Hiroto Kayashima ◽  
Daisuke Imai ◽  
Kazuki Takeishi ◽  
Noboru Harada ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Clinical Characteristics ◽  
Serum Amylase ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Pancreatic Ducts ◽  
Fatal Complication ◽  
Drain Removal ◽  
Soft Pancreas ◽  
Drain Amylase

Postoperative pancreatic fistula (PF) is a relatively frequent and occasionally fatal complication of pancreatoduodenectomy (PD). Several risk factors for PF have been reported, including high drain amylase level (D-AMY). Among the 140 consecutive patients who underwent PD, we analyzed 110 cases with D-AMY measurements over time after PD. According to the D-AMY change, we divided patients into five patterns and defined delayed PF cases. We analyzed clinical characteristics, including serum amylase and D-AMY, and examined the correlation between the period of drain insertion and PF grade. In 15 delayed PF cases, 12 cases were grade B or C, pancreatic cancer was less frequent, pancreatic ducts were smaller, and soft pancreas texture was more commonly observed. The D-AMYon postoperative day (POD) 1 was higher in cases of delayed PF compared with non-PF cases ( P < 0.0001). In 28 cases with drain removal before POD 7, grade B or C PF was not observed afterward. The average D-AMYon POD 1 in cases with drain removal before POD 1 was significantly lower than in delayed PF cases. Although further studies are required to determine the most appropriate timing of drain removal, it is thought that intra-abdominal drains should be removed within seven days of PD in cases without signs of PF. On the other hand, delayed PF should be considered in cases of soft pancreas texture and/or high D-AMY on POD 1, even if D-AMY levels are low on POD 3 or decreasing on POD 5.

scholarly journals DRAIN AMYLASE ON THE FIRST POSTOPERATIVE DAY OF WHIPPLE SURGERY: WHAT VALUE IS THE BEST PREDICTOR FOR EARLY DRAIN REMOVAL?

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Enio Campos AMICO ◽  
Ítalo Medeiros de AZEVEDO ◽  
Marcos Vinicius de Lira FERNANDES ◽  
Mariane Albuquerque REIS ◽  
Samir Assi JOÃO
Keyword(s):  
Positive Predictive Value ◽  
Pancreatic Fistula ◽  
Predictive Value ◽  
Safe Method ◽  
Drain Removal ◽  
Pancreatic Resections ◽  
Group 2 ◽  
Sensitivity Specificity ◽  
Drain Amylase ◽  
Group 1

ABSTRACT Background: The value of drain amylase on the first postoperative day after pancreatic resections has been described as an efficient predictor of pancreatic fistula. In spite of this, the cut-off point below which the drains can be removed early remains controversial. Aim: Validate the use of the amylase on the 1st postoperative day in the correlation with pancreatic fistula and define the value at which early drain removal is safe. Method: Were included patients undergoing Whipple surgery in the period of 2007 to 2016. Group 1 enrolled the ones who did not develop fistula and those who developed biochemical fistula for less than seven days postoperatively and group 2 included patients who developed persistent biochemical fistula between seven and 21 days and those with grade B and C fistula. Results: Sixty-one patients were included, 41 comprised group 1 and 20 group 2. The incidence of abdominal collections, need for reoperation and time of hospitalization were for group 1 and 2, respectively: 17.1%, 17.1% and 9.5 days, and 65%, 40% and 21.1 days. The median of the amylase from the drain at 1st postoperative day was in group 1 and 2, respectively: 175 U/l and 3172.5 U/l (p=0.001). Using a cut-off of 180 to predict the group to which the patient would belong there was obtained sensitivity, specificity, positive predictive value and negative predictive value of 100%, 48.8%, 50% and 100% respectively. Conclusion: It was validated the cut-off value of 180 U/l as appropriate to early drain removal.

A Simple Algorithm for Drain Management after Pancreaticoduodenectomy

2012 ◽  
Vol 78 (10) ◽  
pp. 1143-1146 ◽  
Author(s):  
Nicholas N. Nissen ◽  
Vijay G. Menon ◽  
Vichin Puri ◽  
Alagappan Annamalai ◽  
Brendan Boland
Keyword(s):  
Pancreatic Fistula ◽  
Temporal Pattern ◽  
Management Strategy ◽  
Simple Algorithm ◽  
International Study ◽  
Study Group ◽  
International Study Group ◽  
Drain Removal ◽  
Drain Amylase ◽  
Drain Management

Pancreatic fistula (PF) continues to be the Achilles’ heel of pancreaticoduodenectomy (PD) with both morbidity and mortality linked to its occurrence. The optimal drain management strategy after PD remains unclear. We evaluated drain amylase (DA) levels on postoperative Day (POD) 0 to 5 in 76 consecutive patients undergoing PD to determine the patterns associated with PF. Of these 76 patients, eight patients (11%) developed Grade A, B, or C PF by International Study Group of Pancreatic Fistula criteria. POD 1 DA levels correlated closely with PF rates when high (greater than 5000 U/L, 100% PF rate) and low (less than 100 U/L, 2% PF rate). In patients with intermediate POD 1 DA (100 to 5000 U/L), 42 and 74 per cent had low DA levels on POD 3 and 5, respectively, and the PF rate was four of 31 (13%). Overall, the temporal pattern of decreasing DA levels after PD correlates closely with the risk of PF, and only two patients (5%) developed PF after early DA levels had normalized. Based on these data, we propose an algorithm of monitoring DA daily with drain removal when the level is less than 100 U/L. In our patient group drain removal would have occurred on a mean of 1.8 days and median 1 day after surgery.

scholarly journals Early postoperative outcomes of dunking pancreatojejunostomy

2019 ◽  
Vol 7 (3) ◽  
pp. 833
Author(s):  
Shashikiran M. Shiva Kumar ◽  
Ramesh Rajan ◽  
Sindhu R. Sadasivan Nair ◽  
Bonny Natesh ◽  
Raviram S.
Keyword(s):  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Intestinal Anastomosis ◽  
Postoperative Outcomes ◽  
Gold Standard Method ◽  
Pancreatic Resections ◽  
Clinically Significant ◽  
Drain Amylase ◽  
No Gold Standard ◽  
Pancreatic Gland

Background: There is no gold standard method for pancreatico-enteric reconstruction.  In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice.  In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out 75 (6.6%) developed Grade ‘B’ POPF and three out 75 (3.3%) developed Grade ‘C’ POPF. 20 out 75 (26.6%) had grade ‘A’ DGE, five out of 75(6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (invagination) pancreatojejunostomy has acceptable early outcomes with clinically significant/relevant postoperative pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage rates of 10.4% (grade B and C), 33.2% and 5.3% respectively. The outcomes are comparable with those of Duct-to-Mucosa PJ mentioned in literature.

Early Drain Removal Regardless of Drain Fluid Amylase Level Might Reduce Risk of Postoperative Pancreatic Fistula

2021 ◽  
Vol 41 (1) ◽  
pp. 403-408
Author(s):  
HIROMICHI KAWAIDA ◽  
HIROSHI KONO ◽  
HIDETAKE AMEMIYA ◽  
NAOHIRO HOSOMURA ◽  
YUDAI HIGUCHI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Drain Removal ◽  
Drain Fluid ◽  
Reduce Risk

scholarly journals Assessment of first postoperative day (PO1) drain amylase level threshold in the diagnosis of a pancreatic fistula grade B or C after pancreaticoduodenectomy (PD)

HPB ◽  
2017 ◽  
Vol 19 ◽  
pp. S159
Author(s):  
N. Messaoudi ◽  
X. Para ◽  
Y. Collin ◽  
M. Plasse ◽  
R. Latourneau ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Amylase Level ◽  
Drain Amylase

scholarly journals Passive versus active intra-abdominal drainage following pancreatic resection: does a superior drainage system exist? A protocol for systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031319
Author(s):  
Lily Park ◽  
Laura Baker ◽  
Heather Smith ◽  
Alexandra Davies ◽  
Jad Abou Khalil ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Data Extraction ◽  
Meta Analysis ◽  
Drainage System ◽  
International Study ◽  
Resource Utilisation ◽  
Pancreatic Anastomosis ◽  
Drain Removal ◽  
Central Registry

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) is the most common cause of major morbidity following pancreatic resection. Intra-abdominal drains are frequently positioned adjacent to the pancreatic anastomosis or transection margin at the time of surgery to aid in detection and management of CR-POPF. Drains can either evacuate fluid by passive gravity (PG) or be attached to a closed suction (CS) system using negative pressure. There is controversy as to whether one of these two systems is superior. The objective of this review is to identify and compare the incidence of adverse events (AEs) and resource utilisation associated with PG and CS drainage following pancreatic resections.Methods and analysisMEDLINE, EMBASE, CINAHL and Cochrane Central Registry of Controlled Trials will be searched from inception to April 2019, to identify interventional and observational studies comparing PG and CS drains following pancreatic resection. The primary outcome is POPF as defined by the International Study Group for Pancreatic Fistula in 2017. Secondary outcomes include postoperative AE, resource utilisation (length of stay, return to emergency department, readmission and reintervention), time to drain removal and quality of life. Study selection, data extraction and risk of bias assessment will be performed independently, by two reviewers. A meta-analysis will be conducted if deemed statistically appropriate. Subgroup analysis by study design will be performed. Study heterogeneity will be calculated with the χ2test and reported as I2statistics. Statistical analyses will be conducted and displayed using RevMan V.5.3Ethics and disseminationEthics approval is not required. The results of this study will be submitted to relevant conferences for presentation and peer-reviewed journals for publication.PROSPERO registration numberCRD42019123647.

Postoperative Pancreatic Swelling Predicts Pancreatic Fistula after Pancreaticoduodenectomy

2019 ◽  
Vol 85 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Hiroya Iida ◽  
Masaji Tani ◽  
Hiromitsu Maehira ◽  
Haruki Mori ◽  
Naomi Kitamura ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Protein Level ◽  
Operation Time ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Before And After ◽  
Pancreatic Thickness ◽  
Drain Amylase

Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy. However, the criteria for prompting drainage have not been clarified yet. We evaluated 80 patients who underwent pancreaticoduodenectomy between 2011 and 2016. Clinically relevant POPF (International Study Group of Postoperative Pancreatic Fistula grade B or C) was evaluated on the basis of the following parameters: changes in pancreatic thickness between preoperation and postoperative day (POD) 4 identified via enhanced CT, drain amylase level, laboratory data, and operative factors. POPF occurred in 21 patients (26.3%). The median change in pancreatic thickness before and after operation was 8.33 mm in the POPF-positive group, which was significantly larger than that in the POPF-negative group (3.79 mm, P <0.001). In addition, operation time, pancreatic texture, main pancreatic duct diameter, WBC count, C-reactive protein level, and drain amylase level demonstrated significant differences between the groups. In the multivariate analysis, operation time, C-reactive protein level on POD 3, drain amylase level on POD 1, and the change in pancreatic thickness before and after operation were independent risk factors of POPF. The drastic change in pancreatic thickness before and after operation predicted POPF in this study. This might be one of the factors that determine the requirement for drainage.

scholarly journals Total pancreatectomy and pancreatic fistula: friend or foe?

2021 ◽  
Author(s):  
Roberto Salvia ◽  
Gabriella Lionetto ◽  
Giampaolo Perri ◽  
Giuseppe Malleo ◽  
Giovanni Marchegiani
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Total Pancreatectomy ◽  
Postoperative Pancreatic Fistula ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Surgical Morbidity ◽  
Pancreatic Anastomosis ◽  
Promising Tool

AbstractPostoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.

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