scholarly journals Outcomes of pancreato-gastrostomy and of isolated jejunal loop pancreato-jejunostomy following pancreatoduodenectomy in patients with soft pancreas: a center experience-based analysis

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S663
Author(s):  
G. Zimmitti ◽  
A. Coppola ◽  
F. Ardito ◽  
R. Meniconi ◽  
G.M. Ettorre ◽  
...  
Keyword(s):  
Jejunal Loop ◽  
Soft Pancreas

scholarly journals Water-filled technique for therapeutic pancreato-biliary EUS in patients with surgically altered anatomy

2021 ◽  
Vol 09 (03) ◽  
pp. E487-E489
Author(s):  
Benedetto Mangiavillano ◽  
Silvia Carrara ◽  
Leonardo H. Eusebi ◽  
Franceasco Auriemma ◽  
Mario Bianchetti ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Jejunal Loop ◽  
Surgically Altered Anatomy ◽  
Upper Gastrointestinal

AbstractOne of the main challenges encountered by endosonographers is performing diagnostic and interventional pancreato-biliary endoscopic ultrasound (EUS) procedures in the presence of surgically altered upper gastrointestinal anatomy. We describe the water-filled technique (WFT) for EUS examination and treatment of the pancreato-biliary region in patients with surgically altered upper gastrointestinal anatomy. Using the WFT, the scope is advanced up to the gastro-jejunal anastomosis and, after placing the tip of the scope 2 cm beyond it, enlargement of the jejunal lumen is obtained by water instillation of the jejunal loop. An enlargement of more than 1.5 cm allows advancement of the tip of the scope under EUSguidance up to the duodenum, in a retrograde way. The WFT is useful for reaching the ampullary area and performing diagnostic and therapeutic EUS in patients with surgically altered anatomy. The technique is also reproducible and can be easily used by endoscopists who regularly perform EUS.

scholarly journals Step-by-step esophagojejunal anastomosis after intra-corporeal total gastrectomy for laparoscopic gastric cancer treatment: technique of "reverse anvil"

2014 ◽  
Vol 27 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Croider Franco LACERDA ◽  
Paulo Anderson BERTULUCCI ◽  
Antônio Talvane Torres de OLIVEIRA
Keyword(s):  
Total Gastrectomy ◽  
Circular Stapler ◽  
Jejunal Loop ◽  
Linear Stapler ◽  
Treatment Technique ◽  
Esophagojejunal Anastomosis ◽  
Technical Details ◽  
Gastric Cancer Treatment ◽  
Gastric Tubes ◽  
The Moment

Background: The laparoscopic gastrectomy is a relatively new procedure due mainly to the difficulties related to lymphadenectomy and reconstruction. Until the moment, technique or device to perform the esophagojejunal anastomosis by laparoscopy is still a challenge. So, a safe, cheap and quickly performing technique is desirable to be developed. Aim : To present technique proposed by the authors with its technical details on reconstruction with "reverse anvil". Method: After total gastrectomy completed intra-corporeally, the reconstruction starts with the preparation of the intra-abdominal esophagus cross-section next to the esophagogastric transition of 50%. A graduated device is prepared using Levine gastric tubes (nº. 14 and 10), 3 cm length, connected to the anvil of the circular stapler (nº. 25) with a wire thread (2-0 or 3-0) of 10 cm, which is connected to end of this device. The whole device is introduced in reverse esophagus. The esophagus is amputated and the wire is pulled after previous transfixation in the distal esophagus and the anvil positioned. The jejunal loop is sectioned 20-30 cm from duodenojejunal angle, and the anvil put in the jejunal loop and connect previously in the esophagus. Linear stapler (blue 60 mm) is used to close the opening of the jejunal loop. Conclusion: The "reverse anvil" technique used by the authors facilitated the transit reestablishment after total gastrectomy, contributing to obviate reconstruction problems after total gastrectomy.

scholarly journals Perforated diverticulitis in a patient with very proximal jejunal diverticula

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Constantinos Avgoustou ◽  
Dimitrios Velecheris
Keyword(s):  
Abdominal Distension ◽  
Perforated Diverticulitis ◽  
Jejunal Loop ◽  
Emergency Laparotomy ◽  
Rebound Tenderness ◽  
Cardiac Arrythmias ◽  
Cardiopulmonary Support ◽  
Abdomen Ct ◽  
Fluid Levels ◽  
Jejunal Diverticulitis

Background: We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives. Case presentation: A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished. From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy. Results: Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30. Conclusions: Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.

scholarly journals Frailty is a useful predictive marker of postoperative complications after pancreaticoduodenectomy

2020 ◽  
Author(s):  
YUTAKA NAKANO ◽  
Yuki Hirata ◽  
Tatsuya Shimogawara ◽  
Toru Yamada ◽  
Koki Mihara ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Predictive Factor ◽  
Cardiovascular Health ◽  
Predictive Marker ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Independent Predictive Factor ◽  
Frail Patients ◽  
Soft Pancreas

Abstract BACKGROUND: Frailty results in a high risk for disability, hospitalization, and mortality. This study aimed to investigate perioperative details of frail patients who underwent pancreatectomy and whether frailty can be a predictive factor of postoperative complications, especially of clinically relevant postoperative pancreatic fistula (CR-POPF).METHODS: This retrospective study included patients who underwent pancreatectomy in our hospital between August 2016 and March 2019. The patients were divided into frail and pre-/non-frail groups. The diagnostic criteria were based on the Japanese version of the Cardiovascular Health Study.RESULTS: Of 93 patients, 11 (11.8%) and 82 (88.2%) were frail and pre-/non-frail patients, with median ages of 82 and 72 years, respectively (p=0.041). Postoperative complications (Clavien-Dindo ≧IIIa) were found in 8 and 32 patients (p=0.034), CR-POPF in 3 and 13 patients (p=0.346), and postoperative hospital stays were 21 and 17 days (p=0.041), respectively. On multivariate analysis, frailty was an independent predictive factor (odds ratio [OR] 5.604, 95.0% confidence interval [CI] 1.002-30.734; p=0.047) of postoperative complications (Clavien-Dindo ≧IIIa) after pancreaticoduodenectomy. On multivariate analysis, a soft pancreas (OR 5.696, 95.0% CI 1.142-28.149; p=0.034) was an independent and significant predictive factor of CR-POPF after pancreaticoduodenectomy.CONCLUSIONS: Frailty may be a useful predictive factor of postoperative complications in patients undergoing pancreaticoduodenectomy.

scholarly journals “A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Roux on a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 223-227 ◽  
Author(s):  
Gianluigi Pescio ◽  
Erminio Cariati
Keyword(s):  
Pancreatic Fistula ◽  
Bile Ducts ◽  
Alimentary Tract ◽  
Jejunal Loop ◽  
Linear Stapler ◽  
Suggested Model ◽  
Biliary Anastomosis ◽  
Pancreaticojejunal Anastomosis ◽  
Enterogastric Reflux ◽  
Radionuclide Scanning

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to reconstitute the alimentary tract.The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear Stapler 3-4 centimeters from the biliary anastomosis. In this way, by employing the same loop without mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a stagnant cul-de-sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of leakage, a pure biliary and/or pancreatic fistula as far as is possible.99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction, showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any alkaline enterogastric reflux.

Management of Complications from Hepatobiliary Surgery Using the Percutaneous Trans Jejunal Approach

1997 ◽  
Vol 83 (6) ◽  
pp. 912-917 ◽  
Author(s):  
Aldo Severini ◽  
Guido Cozzi ◽  
Monica Salvetti ◽  
Vincenzo Mazzaferro ◽  
Roberto Doci
Keyword(s):  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Tree ◽  
Jejunal Loop ◽  
Hepatobiliary Surgery ◽  
Management Of Complications ◽  
Therapeutic Procedures ◽  
Intrahepatic Lithiasis ◽  
Intravenous Cholangiography ◽  
Hepatobiliary Complications

Purpose The work was aimed at presenting the indications, techniques and results of the percutaneous transjejunal approach to the biliary tree in patients with hepatobiliary complications due to surgery. Patients and methods Ten patients, 7 males and 3 females, mean age 50 years (range, 10–62) with hepatico-jejunostomy, who developed cholangitis together with jaundice or bile leakage, underwent this procedure, performed through the anastomotic loop that was not surgically anchored to the abdominal wall in all cases but one. The transjejunal approach was chosen because of non-dilated bile ducts in 3 patients, complex pathologic situations in 5 patients and to avoid complications to a transplanted liver in 2 patients. The jejunal loop was identified using CT, US and fluoroscopy in 4 patients and after its opacification in the remaining 6 (by percutaneous transhepatic or intravenous cholangiography or fistulography). Results The procedure was technically and diagnostically successful in all cases. Therapeutic procedures (stenting, dilation, litholysis) were also performed using the transjejunal approach in 7 patients and in 6 of them complete pathological resolution was achieved. There were no complications. Conclusions Different pathologies of the biliary tree, in patients with bilio-enteric anastomoses, have been identified and treated by this technique; they were fistulas, anastomotic and/or multiple segmental benign or malignant stenoses of the bile duct, and diffuse intrahepatic lithiasis. The procedure was safe and reliable.

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