Does preoperative pancreatic duct stenting prevent pancreatic fistula after surgery? A cohort study

Although duct-to-mucosa pancreatojejunostomy has been considered safer than other techniques, this procedure is particularly difficult when the pancreatic duct is small. It has therefore become increasingly necessary to develop a simple mucosal sutureless pancreatojejunostomy technique to replace the conventional hand-sewing one. Two hundred fourteen patients who underwent mucosal sutureless pancreatojejunostomy were classified into two groups: those with a normal pancreatic duct diameter (less than 3 mm, n = 97) and those with a dilated pancreatic duct (3 mm or greater, n = 117). The rate of clinically significant pancreatic fistula (Grade B or C by the International Study Group on Pancreatic Fistula definition) among the patients as a whole was 8 per cent. The overall incidence of pancreatic fistula was significantly higher in the patients with a pancreatic duct diameter of less than 3 mm than in those with a pancreatic duct diameter of 3 mm or greater. However, the incidence of clinically significant pancreatic fistula did not differ between the groups (less than 3 mm, 11%; 3 mm or greater, 5%; P = 0.09). Grade C pancreatic fistula developed in one patient with a pancreatic duct diameter of less than 3 mm and in two with a pancreatic duct diameter 3 mm or greater. Although two patients required reoperation, all of the fistulas were cured and the postoperative mortality rate related to pancreatoduodenectomy was zero. Mucosal sutureless pancreatojejunostomy combined with pancreatic duct stenting is associated with a low rate of clinically significant pancreatic fistula even in patients with a small pancreatic duct diameter less than 3 mm.

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The Effect of Preoperative Biliary Drainage with or without Pancreatic Stenting on Complications after Pancreatoduodenectomy: A Retrospective Cohort Study

BioMed Research International ◽

10.1155/2021/5572395 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Jiangtao Chu ◽

Shun He ◽

Yan Ke ◽

Xudong Liu ◽

Peng Wang ◽

...

Keyword(s):

Cohort Study ◽

Bile Duct ◽

Postoperative Complications ◽

Pancreatic Duct ◽

Anastomotic Leakage ◽

Complication Rate ◽

Biliary Drainage ◽

Preoperative Biliary Drainage ◽

Gastrointestinal Dysfunction ◽

Pancreatic Duct Stenting

Background. The necessity of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) is still controversial. However, in some settings, PBD with endoscopic retrograde cholangiopancreatography (ERCP) procedure is recommended as a preferred management. Meanwhile, pancreatic duct stenting in the drainage procedure is rarely performed for selected indications, and its associated complications after PD remain quite unknown. Methods. A retrospective observational longitudinal cohort study was performed on patients who underwent PBD and PD from a prospectively maintained database at the National Cancer Center from March of 2015 to July of 2019. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, were distributed into two study cohort groups, and their records were scrutinized for the incidence of postoperative complications. Results. A total of 83 patients who underwent successful PD after biliary drainage were identified. 29 patients underwent nasobiliary drainage (ENBD)/plastic or metal bile duct stenting (BS) and pancreatic duct stenting (PS group), and 54 patients underwent only ENBD/BS, without pancreatic duct stenting (NPS group). No differences were found between the two groups with respect to in-hospital time, overall complication rate, respective rate of serious (grade 3 or higher) complication rate, bile anastomotic leakage, bleeding, abdominal infection, surgical wound infection, organ dysfunction, and pancreatic anastomotic leakage. Postoperative gastrointestinal dysfunction rates differed significantly, which occurred in 3 (5.56%) cases in the NPS group, compared with 6 (20.7%) cases in the PS group ( P = 0.06 ). In the univariate and multivariate regression model analysis, pancreatic duct stenting was correlated with higher rates of gastrointestinal dysfunction [ odds ratio OR = 4.25 , P = 0.0472 ]. Conclusion. Our data suggested that PBD and pancreatic duct stenting prior to pancreatoduodenectomy would increase the risk of postoperative delayed gastric emptying, while the overall incidence of postoperative complications and other complications, such as pancreatic leakage and bile duct leakage, showed no statistical difference.

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Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial

Journal of Gastrointestinal Surgery ◽

10.1016/j.gassur.2006.07.020 ◽

2006 ◽

Vol 10 (9) ◽

pp. 1280-1290 ◽

Cited By ~ 216

Author(s):

J WINTER ◽

J CAMERON ◽

K CAMPBELL ◽

D CHANG ◽

T RIALL ◽

...

Keyword(s):

Randomized Trial ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Prospective Randomized Trial ◽

Pancreatic Duct Stenting

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Preoperative pancreatic duct stenting in patients undergoing laparoscopic pancreatic surgery – a preliminary report

Polish Journal of Surgery ◽

10.1515/pjs-2015-0059 ◽

2015 ◽

Vol 87 (6) ◽

Cited By ~ 1

Author(s):

Mateusz Rubinkiewicz ◽

Marcin Migaczewski ◽

Michał Pędziwiatr ◽

Maciej Matłok ◽

Marcin Dembiński ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Surgery ◽

Uncinate Process ◽

The Body ◽

Open Approach ◽

Laparoscopic Pancreatic Surgery ◽

Pancreatic Duct Stenting ◽

Laparoscopic Pancreatic Resection

AbstractLaparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum.The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery.Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery.Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery.Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.

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Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1719222 ◽

2021 ◽

Author(s):

Ayah Megahed ◽

Rahul Hegde ◽

Pranav Sharma ◽

Rahmat Ali ◽

Anas Bamashmos

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pleural Fluid ◽

Rare Complication ◽

Delayed Diagnosis ◽

Magnetic Resonance Cholangiopancreatography ◽

Pleural Effusions ◽

Diagnostic Challenge ◽

Abdominal Symptoms ◽

Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

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Critical Grade C Postoperative pancreatic fistula (POPF) treated with reoperation and direct drainage of the main pancreatic duct

Suizo ◽

10.2958/suizo.36.385 ◽

2021 ◽

Vol 36 (6) ◽

pp. 385-393

Author(s):

Takashi KATO ◽

Hirohisa KITAGAWA ◽

Kazuki HASHIDA ◽

Kazuyuki KAWAMOTO

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Postoperative Pancreatic Fistula ◽

Critical Grade

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Pancreatic fistulae following pancreatic resection. Analysis of causes and prevention methods

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(4)-11 ◽

2018 ◽

Vol 22 (4) ◽

pp. 640-646

Author(s):

K.G. Valikhnovska

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Head ◽

Preoperative Period ◽

External Drainage ◽

Distal Pancreatic Resection ◽

Glycemic Level ◽

Prevention Methods

The causes of pancreatic fistula were analyzed in 503 patients aged from 22 to 81who underwent pancreaticoduodenectomy for pancreatic and periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve the outcomes of pancreatic resection based on a retrospective analysis of the risk factors of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. The influence of factors on the risk of pancreatic fistula was investigated by Pearson method (χ2). The factors contributing to the occurrence of pancreatic fistulae included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head, χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=12.75,1, p<0.001), technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage, χ2=44.01,1, p<0.0001), resection of venous vessels following distal pancreatic resection (χ2=8.350,1, p=0.0039, p<0.01), glycemic level in the preoperative period (P=0.0344,U=15061), the presence of concomitant diseases in patients (χ2=15.62,1, p=0.0001, p<0.001). Preoperative glycemic level and the presence of concomitant diseases in patients are factors that can be influenced to prevent the onset of pancreatic fistula in the postoperative period in patients who are scheduled for pancreatic resection. Prevention of this complication involves the correction of glycemic level and treatment of concomitant pathology in patients in the preoperative period.

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