scholarly journals Does drain amylase < 666 IU/L on the third post-operative day effectively predicts the absence of a high-impact postoperative pancreatic fistula following pancreaticoduodenectomy?

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e111 ◽  
Author(s):  
M. Srivastava ◽  
V. Kumaran ◽  
S. Nundy
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
High Impact ◽  
The Third ◽  
Drain Amylase

scholarly journals Serum and drain amylase to rule-out postoperative pancreatic fistula after pancreatoduodenectomy

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S217
Author(s):  
J. Van Dongen ◽  
H. Aziz ◽  
S. Merkens ◽  
B Groot Koerkamp ◽  
C. Van Eijck
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Drain Amylase ◽  
Rule Out

scholarly journals Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Modified Method ◽  
Early Removal ◽  
Soft Pancreas

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

scholarly journals Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
P Value ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Modified Method ◽  
Soft Pancreas

Abstract Background: Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods: In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n=67) and a modified group (n = 56).Results: The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p-value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p-value = 0.002).Conclusions: Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

scholarly journals Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Bo Li ◽  
Ning Pu ◽  
Qiangda Chen ◽  
Yong Mei ◽  
Dansong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Predictive Value ◽  
Predictive Accuracy ◽  
Postoperative Pancreatic Fistula ◽  
Diagnostic Model ◽  
Discriminative Ability ◽  
Reactive Protein ◽  
Independent Risk Factors ◽  
Drain Amylase

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) remains a severe and challenging complication of pancreaticoduodenectomy (PD). This study aimed to establish a novel postoperative nomogram-based diagnostic model for the early detection of CR-POPF in patients subjected to PD.MethodsConsecutive patients who underwent PD in Zhongshan Hospital, Fudan University from December 2018 to October 2020 were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CR-POPF. Then, a novel predictive nomogram was established accordingly.ResultsAmong the consecutive 176 patients who underwent PD, 37 (21.1%) patients developed CR-POPF. Through univariate and multivariate analyses, the drain amylase (P = 0.002), serum creatinine (P = 0.009), and serum C reactive protein (P = 0.045) at postoperative day 1 (POD1) as well as the neutrophil count (P = 0.025) and temperature (P = 0.025) at POD3 were identified as independent risk factors for CR-POPF. Based on this, a novel predictive nomogram containing these factors was constructed to predict the probability of CR-POPF after PD. The formulated nomogram showed better performance to detect CR-POPF after PD with a sensitivity of 0.784, specificity of 0.770, positive predictive value of 0.475, and negative predictive value of 0.930 when compared to other predictors. In addition, the predictive value of the nomogram was assessed by a concordance index of 0.814 (95% CI, 0.736–0.892), which was significantly higher than indicators alone. This was further validated and depicted by decision curve analysis and clinical impact curve.ConclusionThis study established a diagnostic nomogram of postoperative objective parameters that can predict the development of CR-POPF after PD with a good discriminative ability and predictive accuracy.

scholarly journals Original Scientific Report Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Early Removal ◽  
Soft Pancreas ◽  
Scientific Report

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and December 2019 were analyzed. We divided these patients into two groups: a conventional group (n = 67) and a modified group (n = 53).Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (1.9% vs 22.4%, p < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group had reduced to one third of those in the conventional group (1696 vs 643 U/L).Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

Efficacy of Enteral Nutrition by Double Elementary Diet Tube after Pylorus-Preserving Pancreatoduodenectomy

2019 ◽  
Vol 85 (4) ◽  
pp. 359-364 ◽  
Author(s):  
Toru Sano ◽  
Naokazu Chiba ◽  
Takahiro Gunji ◽  
Yosuke Ozawa ◽  
Kosuke Hikita ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Pancreatic Fistula ◽  
Nutritional Support ◽  
Lumbar Vertebra ◽  
Postoperative Pancreatic Fistula ◽  
Muscle Area ◽  
The Third ◽  
Soft Pancreas ◽  
Parental Nutrition ◽  
Skeletal Muscle Area

Nutritional support after pylorus-preserving pancreaticoduodenectomy (PpPD) is still controversial. This study aimed to evaluate the efficacy of enteral nutrition (EN) via the double elementary diet (W-ED) tube after PpPD. One hundred two patients who received EN by the W-ED tube were compared with 52 patients who received total parental nutrition (TPN) previously. Clinicopatho-logical and postoperative features were analyzed among the two groups. Patients with EN by the W-ED tube after PpPD had a lower incidence of postoperative pancreatic fistula than those with TPN. The total protein and albumin levels on discharge in the EN group were significantly higher than those in the TPN group. In the case without complication, decreasing rate of the third lumbar vertebra skeletal muscle area was significantly lower in the EN group. In the cases of soft pancreas, drainage volume by the W-ED tube until four postoperative day was significantly larger in the case without postoperative pancreatic fistula. The W-ED tube offers the advantages of reducing gastrointestinal pressure and enabling reduction of complications after PpPD 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.

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