scholarly journals High Risk Pancreatic Anastomosis: Does External Pancreatic Stent Help?

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S449
Author(s):  
R N Naga santhosh Irrinki ◽  
Vikas Gupta ◽  
Yashwanth Raj Sakaray ◽  
Pradeep Kumar ◽  
Vikash Moond
Keyword(s):  
High Risk ◽  
Pancreatic Stent ◽  
Pancreatic Anastomosis

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.

scholarly journals Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

2015 ◽  
Vol 4 (2) ◽  
pp. 67-71
Author(s):  
Hossein Ajdarkosh ◽  
Gholamreza Hemasi ◽  
Farhad Zamani ◽  
Masoudreza Sohrabi ◽  
Mohammad Mahdi Zamani ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Stent Placement ◽  
Guide Wire ◽  
High Risk Population ◽  
Pancreatic Stent ◽  
Stent Group ◽  
Endoscopic Retrograde ◽  
Pancreatic Duct Stent

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]

scholarly journals Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2181
Author(s):  
Marco V. Marino ◽  
Adrian Kah Heng Heng Chiow ◽  
Antonello Mirabella ◽  
Gianpaolo Vaccarella ◽  
Andrzej L. Komorowski
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Pancreatic Fistula ◽  
Operative Time ◽  
Risk Group ◽  
High Risk Group ◽  
Retrospective Case ◽  
Pancreatic Anastomosis ◽  
Robotic Assisted ◽  
Estimated Blood Loss

Background: Different techniques of pancreatic anastomosis have been described, with inconclusive results in terms of pancreatic fistula reduction. Studies comparing robotic pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are scarcely reported. Methods: The present study analyzes the outcomes of two case-matched groups of patients who underwent PG (n = 20) or PJ (n = 40) after pancreaticoduodenectomy. The primary aim was to compare the rate of post-operative pancreatic fistula. Results: Operative time (375 vs. 315 min, p = 0.34), estimated blood loss (270 vs. 295 mL, p = 0.44), and rate of clinically relevant post-operative pancreatic fistula (12.5% vs. 10%, p = 0.82) were similar between the two groups. PJ was associated with a higher rate of intra-abdominal collections (7.5% vs. 0%, p = 0.002), but lower post-pancreatectomy hemorrhage (2.5% vs. 10%, p = 0.003). PG was associated with a lower rate of post-operative pancreatic fistula (POPF) (33.3% vs. 50%, p = 0.003) in the high-risk group of patients. Conclusions: The outcomes of post-operative pancreatic fistula are comparable between the two reconstruction techniques. PG may have a lower incidence of POPF in patients with high-risk of pancreatic fistula.

scholarly journals Moderate and Severe Postendoscopic Retrograde Cholangiopancreatography Pancreatitis Despite Prophylactic Pancreatic Stent Placement: The Effect of Early Prophylactic Pancreatic Stent Dislodgement

2011 ◽  
Vol 25 (4) ◽  
pp. 215-219 ◽  
Author(s):  
Dana C Moffatt ◽  
Pradermchai Kongkam ◽  
Haritha Avula ◽  
Stuart Sherman ◽  
Evan L Fogel ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Stent Placement ◽  
Pancreatic Stent ◽  
High Risk Patients ◽  
Before And After ◽  
Risk Patients ◽  
The Mean ◽  
Length Of Hospitalization

BACKGROUND: Placement of prophylactic pancreatic stents (PPS) is a method proven to reduce the rate and severity of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; however, PPS do not eliminate the risk completely. Early PPS dislodgement may occur prematurely and contribute to more frequent or severe PEP.OBJECTIVE: To determine the effect of early dislodgement of PPS in patients with moderate or severe PEP.METHOD: A total of 27,176 ERCP procedures from January 1994 to September 2007 for PPS placement in high-risk patients were analyzed. Patient and procedure data were analyzed to assess risk factors for PEP, and to evaluate the severity of pancreatitis, length of hospitalization and subsequent complications. Timing of stent dislodgment was assessed radiographically.RESULTS: PPS were placed in 7661 patients. Of these, 580 patients (7.5%) developed PEP, which was graded as mild in 460 (6.0%), moderate in 87 (1.1%) and severe in 33 (0.4%). Risk factors for developing PEP were not different in patients who developed moderate PEP compared with those with severe PEP. PPS dislodged before 72 h in seven of 59 (11.9%) patients with moderate PEP and five of 27 (18.5%) patients with severe PEP (P=0.505). The mean (± SD) length of hospitalization in patients with moderate PEP with stent dislodgement before and after 72 h were 7.43±1.46 days and 8.37±1.16 days, respectively (P=0.20). The mean length of hospitalization in patients with severe PEP whose stent dislodged before and after 72 h were 21.6±6.11 and 22.23±3.13 days, respectively (P=0.96).CONCLUSION: Early PPS dislodgement was associated with moderate and severe PEP in less than 20% of cases and was not associated with a more severe course. Factors other than ductal obstruction contribute to PEP in high-risk patients undergoing ERCP and PPS placement.

scholarly journals Amniotic Membrane over Pancreatic Anastomosis after High Risk Pancreaticoduodenectomy: Preliminary Experience of a Prospective Study

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S437
Author(s):  
I. Frigerio ◽  
E. Bannone ◽  
D. Trojan ◽  
P. Regi ◽  
R. Girelli ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Amniotic Membrane ◽  
Pancreatic Anastomosis ◽  
A Prospective Study

scholarly journals Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

2015 ◽  
Vol 156 (18) ◽  
pp. 715-719 ◽  
Author(s):  
Árpád Patai ◽  
Árpád V. Patai ◽  
Norbert Solymosi ◽  
Zsolt Tulassay ◽  
László Herszényi
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Relevant Literature ◽  
Careful Consideration ◽  
Fluid Replacement ◽  
Pancreatic Stent ◽  
Lethal Outcome ◽  
Endoscopic Retrograde ◽  
Risk Patients ◽  
Rectal Indomethacin

Over 14,000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with lethal outcome. This article is aimed to review recent relevant literature and to present a practical guide based on the authors’ own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac and adequate intravenous fluid replacement. Orv. Hetil., 2015, 156(18), 715–719.

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