A Simple and Secure Ligation of the Main Pancreatic Duct in Distal Pancreatectomy

2013 ◽  
Vol 216 (3) ◽  
pp. e23-e25 ◽  
Author(s):  
Yuji Soejima ◽  
Ken Shirabe ◽  
Tomoharu Yoshizumi ◽  
Toru Ikegami ◽  
Yoichi Yamashita ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct

scholarly journals Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

2021 ◽  
Vol 28 (2) ◽  
pp. 33-45
Author(s):  
E. S. Drozdov ◽  
E. B. Topolnitskiy ◽  
S. S. Klokov ◽  
T. V. Dibina
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Study ◽  
Morphological Examination ◽  
Distal Pancreatic Resection ◽  
Duct Diameter

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

Article Commentary: Management of Left Pancreatic Trauma

2011 ◽  
Vol 77 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Brice Malgras ◽  
Richard Douard ◽  
Nathalie Siauve ◽  
Philippe Wind
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Diagnostic Modality ◽  
Spleen Preserving ◽  
Endoscopic Techniques ◽  
Pancreatic Duct Stenting ◽  
Pancreatic Fistulas

Left pancreatic traumas (LPTs) are rare but serious lesions occurring in 1 to 6 per cent of abdominal trauma patients and mainly resulting from blunt traumas. LPT severity is primarily dependent on the associated injuries and secondarily related to main pancreatic duct injury responsible for complications: acute pancreatitis, pseudocysts, pancreatic fistulas, or abscesses. The guidelines for blunt LPT management can be presented as follows. In case of emergency laparotomy, pancreas exploration is mandatory to detect pancreatic duct lesions. In the absence of main pancreatic duct lesions, simple drainage is advocated. In case of distal injury to the main pancreatic duct, a left pancreatectomy is mandatory. In the absence of initial laparotomy, the diagnosis is more and more based on CT and magnetic resonance cholangiopancreatography, which tend to replace endoscopic retrograde cholangiopancreatography (ERCP) as a first-intent diagnostic modality. In case of distal injury to the main pancreatic duct, spleen-preserving distal pancreatectomy is recommended. In the absence of main pancreatic duct lesions, nonoperative treatment is advocated. When LPTs are discovered at the time of complications, pancreatic fistulas and/or pseudocysts are associated with main pancreatic lesions, which can be treated by pancreatic duct stenting at ERCP and/or internal endoscopic cystogastrostomy. However, in such cases, spleen-preserving distal pancreatectomy remains the treatment of choice. Pancreatic ductal lesions resulting from LPT have to be diagnosed early to avoid late complications. Distal pancreatectomy remains the treatment of choice in case of severe pancreatic ductal lesions because the role of ERCP stenting and endoscopic techniques needs further evaluation.

Stenting of the main pancreatic duct during distal pancreatectomy

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S116
Author(s):  
Dezső Kelemen ◽  
Róbert Papp ◽  
Zsanett Bíró ◽  
Levente Kucserik ◽  
András Vereczkei
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct

Pancreatic Cyst: Pseudocyst or Neoplasm? Pitfalls in Endoscopic Retrograde Cholangiopancreatography Diagnosis

2010 ◽  
Vol 76 (7) ◽  
pp. 725-730
Author(s):  
Clayton Tyler Ellis ◽  
John R. Barbour ◽  
Thomas M. Shary ◽  
David B. Adams
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Main Pancreatic Duct ◽  
Pancreatic Cyst ◽  
Mucinous Cystadenoma ◽  
Cystic Lesions ◽  
Endoscopic Retrograde ◽  
Pancreatic Tail ◽  
History Of

Pancreatic pseudocysts represent the majority of cystic lesions, and can usually be differentiated from cystic neoplasms, which have malignant potential. Endoscopic retrograde cholangiopancreatography (ERCP) can help in solving diagnostic dilemmas. When ERCP demonstrates cyst communication with the pancreatic duct, the diagnosis of pseudocyst is usually secure. There are exceptions, however, as reported in these two case reports. A retrospective chart review was conducted of two patients undergoing distal pancreatectomy in 2008 to 2009 for cystic lesions communicating with the main pancreatic duct on ERCP. Both patients were women (ages 37 and 42) with a history of chronic abdominal pain and pancreatitis. Radiologic imaging showed cystic lesions in the pancreatic tail. ERCP demonstrated main pancreatic duct communication. When endoscopic management failed, surgical therapy was undertaken. Both patients underwent distal pancreatectomy with splenectomy. Pathologic findings were mucinous cystadenoma. The conventional wisdom that a pancreatic cyst communicating with the main pancreatic duct is a benign pseudocyst is not always wise. As seen in this series, mucinous cystadenomas can erode into the main pancreatic duct. Women in the fourth and fifth decade with symptomatic cysts in the pancreatic tail with a history of pancreatitis should undergo distal pancreatectomy, regardless of ductal communication on ERCP.

scholarly journals Pancreatic ductal adenocarcinoma in a patient with pancreas divisum and gastrointestinal duplication cyst: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoto Takahashi ◽  
Hiroyuki Nitta ◽  
Akira Umemura ◽  
Hirokatsu Katagiri ◽  
Shoji Kanno ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Duplication Cyst ◽  
Ductal Adenocarcinoma ◽  
Ct Examination ◽  
History Of

Abstract Background The complication of duplication of alimentary tracts and pancreas divisum (PD) is a rare malformation and the development of pancreatic ductal adenocarcinoma (PDAC) in this malformation is also extremely rare. There have been some reports of complication of malignancy in a gastric duplication cyst (GDC) and PD. However, there have been no reports of complication of PDAC in cases with GDC and PD. Case presentation A 54-year-old woman was followed up at the previous hospital due to a history of ovarian endometrial adenocarcinoma. She also had a surgical history of partial excision for a GDC and pancreatic tail of PD in her childhood. A gynecological follow-up computed tomography (CT) examination revealed the pancreatic body tumor and the bifurcated main pancreatic duct dilatation. Furthermore, magnetic resonance cholangiopancreatography also revealed that the ventral main pancreatic duct communicated with the GDC. The initial levels of tumor markers were high, but we could not achieve preoperative histopathological diagnosis. The preoperative diagnosis was PDAC occurring in a case with PD and GDC. She received two courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel. A CT examination after neoadjuvant chemotherapy revealed the shrinkage of the tumor, and then we performed distal pancreatectomy with splenectomy and GDC resection. A histopathological examination revealed invasive PDAC and lymph node metastases; pathological staging was T1N1M0, stage III. Furthermore, PD and GDC were also histopathologically detected. The postoperative course was uneventful, and she was discharged on the postoperative day 25. She received S-1 monotherapy for 6 months, and no recurrence has been detected at 1 year after radical resection. Conclusions We herein presented an extremely rare combined case of PD, GDC and PDAC. We successfully treated it by neoadjuvant chemotherapy and distal pancreatectomy with GDC resection, and postoperative chemotherapy.

scholarly journals Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

Objectives. Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discuss the risk factors of pancreatic fistula in order to interpret the clinical importance. Methods. In this retrospective study, 263 patients who underwent DP at Ningbo Medical Center Li Huili Hospital between January 2011 and January 2020 were reviewed in accordance with relevant guidelines and regulations. Patients’ demographics and clinical parameters were evaluated using univariate and multivariate analyses to identify the risk factors contributing to CR-POPF. P < 0.05 was considered statistically significant. Results. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication (19.0%). The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct were more likely to develop pancreatic fistula. However, on multivariate analysis, the soft texture of the pancreas (OR = 2.381, 95% CI = 1.271–4.460, P = 0.001 ) and the ligation of the main pancreatic duct (OR = 0.388, 95% CI = 0.207–0.726, P = 0.002 ) were only an independent influencing factor for CR-POPF. Conclusions. As a conclusion, pancreatic fistula was the most common surgical complication after DP. The soft texture of the pancreas and the absence of ligation of the main pancreatic duct can increase the risk of CR-POPF.

scholarly journals Effect of different pancreatic stump closure techniques after distal pancreatectomy on frequency and severity of acute postoperative pancreatitis

2020 ◽  
Author(s):  
Sergei Voskanyan ◽  
Evgeny Naydenov ◽  
Igor Uteshev ◽  
Aleksei Artemiev
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Severe Form ◽  
Control Group ◽  
Pancreatic Stump ◽  
Postoperative Pancreatitis ◽  
Stump Closure ◽  
Group 2 ◽  
Linear Cutter

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.

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