scholarly journals Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

2020 ◽  
Vol 405 (8) ◽  
pp. 1219-1231
Author(s):  
Sergio Pedrazzoli ◽  
Alessandra R. Brazzale
Keyword(s):  
Pancreatic Fistula ◽  
English Literature ◽  
Meta Analysis ◽  
Pool Analysis ◽  
Incidence Rates ◽  
Postoperative Pancreatic Fistula ◽  
Standard Management ◽  
Drain Removal ◽  
Number Of Patients ◽  
Related Mortality

Abstract Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

Preoperative and intraoperative risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy – systematic review and meta-analysis

2021 ◽  
Vol 93 (6) ◽  
pp. 1-10
Author(s):  
Kajetan Kiełbowski ◽  
Estera Bakinowska ◽  
Rafał Uciński
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Significant Risk ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Anastomosis ◽  
Pancreatic Fat ◽  
Number Of Patients ◽  
Potential Risk Factors ◽  
Mean Differences

Introduction: Postoperative pancreatic fistula (POPF) is a potentially life-threatening complication after pancreaticoduodenectomy (PD). It is observed when the amylase activity in the drain fluid exceeds three times the normal upper value. Grades B and C of POPF are considered as clinically relevant. Fistula might originate due to failure of healing of a pancreatic anastomosis or from raw pancreatic surface. Materials and methods: 18 retrospective and prospective studies published between 2015 and 2020 were included in this meta-analysis. Total number of patients was 5836. To investigate potential risk factors associated with the occurrence of POPF, odds ratios (OR) with 95% confidence intervals (CI) were calculated. To compare discontinuous data, mean differences (MD) were calculated. Results: 13 factors were divided into preoperative and intraoperative groups. Male sex, higher BMI, soft pancreatic texture and small pancreatic duct were considered as significant risk factors while vascular resection lowered the risk of development pancreatic fistula. Discussion: It is considered that the development of POPF is associated with intrapancreatic fat. More severe infiltration with fat tissue is responsible for soft texture of the gland, while higher BMI is one of the risk factors of increased pancreatic fat. On the contrary, diabetes is associated with fibrotic pancreas which could lower the risk of developing POPF.

Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection

2018 ◽  
Vol 84 (1) ◽  
pp. 149-153 ◽  
Author(s):  
Takao Ohtsuka ◽  
Yasuhisa Mori ◽  
Takaaki Fujimoto ◽  
Yoshihiro Miyasaka ◽  
Kohei Nakata ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Medical Records ◽  
Operation Time ◽  
Postoperative Pancreatic Fistula ◽  
Postoperative Hospital Stay ◽  
High Risk Patients ◽  
Risk Patients ◽  
Related Mortality

The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with ( n = 10) and without ( n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer ( P < 0.01) and blood loss significantly greater ( P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent ( P = 0.02) and postoperative hospital stay was significantly longer ( P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Operation Time ◽  
Bile Leakage ◽  
Reoperation Rate ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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 Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 34 (4) ◽  
pp. 265-280 ◽  
Author(s):  
Xianbin Zhang ◽  
Xin Dong ◽  
Peng Liu ◽  
Yumei Yan ◽  
Yushan Wei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Postoperative Pancreatic Fistula
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