Total pancreatectomy and pancreatic fistula: friend or foe?

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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P-P03 Impact of routine nasogastric decompression versus no nasogastric decompression after pancreatoduodenectomy on perioperative outcomes: A meta-analysis of available evidence

British Journal of Surgery ◽

10.1093/bjs/znab430.227 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Khaled Ammar ◽

Chris Varghese ◽

Thejasvin K ◽

Viswakumar Prabakaran ◽

Stuart Robinson ◽

...

Keyword(s):

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Postoperative Pancreatic Fistula ◽

Current Evidence ◽

Perioperative Outcomes ◽

The Impact ◽

Nasogastric Decompression

Abstract Background This meta-analysis reviewed the current evidence on the impact of routine Nasogastric decompression (NGD) versus no NGD after pancreatoduodenectomy on perioperative outcomes. Methods PubMed, Medline, Scopus, Embase and Cochrane databases were searched for studies reporting the role of nasogastric tube decompression after pancreatoduodenectomy on perioperative outcomes were retrieved and analysed up to January 2021. Results Eight studies with total of 1301 patients were enrolled of which 668 patients had routine NGD. Routine NGD was associated with a higher incidence of overall delayed gastric emptying (DGE) and clinically relevant DGE (OR = 2.51, 95% CI; 1.12 - 5.63, I2= 83%, P = 0.03, and OR = 3.64, 95% CI: 1.83 – 7.25, I2 = 54%, P < 0.01, respectively). Routine NGD was also associated with a higher rate of Clavien-Dindo ≥ 2 complications (OR = 3.12, 95% CI: 1.05 – 9.28, I2 = 88%, P = 0.04), and increased length of hospital stay (MD = 2.67, 95% CI: 0.60 – 4.75, I2 = 97%, P = 0.02). There were no significant differences in overall complications (OR = 1.07, 95% CI: 0.79 – 1.46, I2 0%, P = 0.66), or postoperative pancreatic fistula (OR = 1.21, 95% CI: 0.86 – 1.72, I2 = 0%, P = 0.28) between the two groups. Conclusions Routine NGD may be associated with increased rates of DGE, major complications and longer length of stay after pancreatoduodenectomy.

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Using serum biomarkers for identifying unstable carotid plaque: update of current evidence

Current Pharmaceutical Design ◽

10.2174/1381612826666201112094734 ◽

2020 ◽

Vol 26 ◽

Author(s):

Areti Sofogianni ◽

Konstantinos Tziomalos ◽

Triantafyllia Koletsa ◽

Apostolos G. Pitoulias ◽

Lemonia Skoura ◽

...

Keyword(s):

High Risk ◽

Great Proportion ◽

Current Literature ◽

Early Identification ◽

Carotid Plaque ◽

Potential Role ◽

Carotid Atherosclerosis ◽

Serum Biomarkers ◽

Current Evidence

: Carotid atherosclerosis is responsible for a great proportion of ischemic strokes. Early identification of unstable or vulnerable carotid plaques and therefore of patients at high risk for stroke is of significant medical and socioeconomical value. We reviewed the current literature and discuss the potential role of the most important serum biomarkers in identifying patients with carotid atherosclerosis who are at high risk for atheroembolic stroke.

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

The American Surgeon ◽

10.1177/000313481808400138 ◽

2018 ◽

Vol 84 (1) ◽

pp. 149-153 ◽

Cited By ~ 1

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.

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The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

Innovative Surgical Sciences ◽

10.1515/iss-2020-0021 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Georgi Kalev ◽

Christoph Marquardt ◽

Herbert Matzke ◽

Paul Matovu ◽

Thomas Schiedeck

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Pancreatic Head ◽

Suture Technique ◽

Postoperative Pancreatic Fistula ◽

Intermediate Care ◽

Pancreatic Head Resection ◽

Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

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Role of extracellular matrix structural components and tissue mechanics in the development of postoperative pancreatic fistula

Journal of Biomechanics ◽

10.1016/j.jbiomech.2021.110714 ◽

2021 ◽

Vol 128 ◽

pp. 110714

Author(s):

Rosa B. Schmuck ◽

Evi Lippens ◽

Dag Wulsten ◽

Daniela S. Garske ◽

Annika Strönisch ◽

...

Keyword(s):

Extracellular Matrix ◽

Pancreatic Fistula ◽

Tissue Mechanics ◽

Postoperative Pancreatic Fistula ◽

Structural Components

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Retrospective Comparative Analysis of POPF Using Fistula Risk Score According to Pancreaticoenterostomy Method

International Surgery ◽

10.9738/intsurg-d-20-00033.1 ◽

2021 ◽

Vol 105 (1-3) ◽

pp. 559-563

Author(s):

Seungmin Lee ◽

Kwang Yeol Paik

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Risk Score ◽

Risk Group ◽

Risk Groups ◽

High Risk Group ◽

Postoperative Pancreatic Fistula ◽

Clinical Risk Score ◽

Reconstructive Methods ◽

Fistula Risk Score

Background The aim of this study is to examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. A total of 159 patients were stratified into 4 groups according to the Clinical Risk Score-Pancreatic Fistula. POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 17.1% (n = 14) in the PG group and 12.9% (n = 10) in the PJ group (P = 0.51). POPF rates were not different in intermediate, low, and negligible risks between 2 reconstructive methods. In the high-risk group (n = 47), there were 4 POPFs (22.2%) in PJ group and 9 (31.0%) in the PG group, respectively (P = 0.74). Conclusion In PD, there was no superior method of reconstruction with regard to POPF, even in high-risk glands.

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