Wrapping double-mattress anastomosis for pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy can significantly reduce postoperative pancreatic fistula rate compared with conventional pancreaticojejunostomy in open surgery: An analysis of a propensity score-matched sample

2021 ◽  
pp. 101577
Author(s):  
Gozo Kiguchi ◽  
Atsushi Sugioka ◽  
Yuichiro Uchida ◽  
Junichi Yoshikawa ◽  
Masaya Nakauchi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Pancreatic Fistula ◽  
Open Surgery ◽  
Postoperative Pancreatic Fistula ◽  
Matched Sample ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

scholarly journals Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture 

2020 ◽  
Author(s):  
Gozo Kiguchi ◽  
Atsushi Sugioka ◽  
Masaya Nakauchi ◽  
Masayuki Kojima ◽  
Akira Yasuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Texture ◽  
Technical Issues ◽  
Fistula Rate ◽  
Robotic Pancreaticoduodenectomy ◽  
Open Pancreaticoduodenectomy

Abstract Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.

Development of an Intraoperative Indicator of Pancreatic Leakage to Reduce Postoperative Pancreatic Fistula Rate

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S121-S122
Author(s):  
Thomas Pausch ◽  
Clara Mitzscherling ◽  
Christoph Michalski ◽  
Jörg Kaiser ◽  
Thilo Hackert
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Leakage ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

scholarly journals A Novel Anastomosis Technique for Laparoscopic Pancreaticoduodenectomy: Case Series of Our Center's Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Pi-Jiang Sun ◽  
Yan-Hua Yu ◽  
Jian-Wei Li ◽  
Xi-Jun Cui
Keyword(s):  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Operative Time ◽  
Postoperative Bleeding ◽  
Length Of Hospital Stay ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Postoperative Length ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

Background: Laparoscopic pancreaticoduodenectomy has developed rapidly in recent years. Postoperative pancreatic fistula is still the most dangerous complication of laparoscopic pancreaticoduodenectomy. Baumgart pancreaticojejunostomy is considered one of the safest anastomosis procedures, with low rates of pancreatic fistula. We modified Blumgart pancreaticojejunostomy and applied the modified procedure during laparoscopic pancreaticoduodenectomy. The modified procedure entailed a longitudinal U-shaped suture through the pancreas for anastomosis of the pancreatic duct and the jejunal mucosa.Methods: We prospectively collected and retrospectively analyzed the data of 120 patients who underwent laparoscopic pancreaticoduodenectomy from January 2016. The total operative time, time for complete pancreaticojejunostomy, postoperative pancreatic fistula rate, postoperative delayed gastric emptying, postoperative bleeding, postoperative length of hospital stays, and mortality within 90 days after surgery were analyzed. An analysis of laparoscopic pancreaticojejunostomy compared with open pancreaticojejunostomy is also reported.Results: In the laparoscopic pancreaticojejunostomy group, the average total operative time, the average time for complete pancreaticojejunostomy, and the average intraoperative blood loss were 271 min, 35.3 min, and 184 ml, respectively. The total postoperative clinically relevant pancreatic fistula rate was 9.2% (Grade B and C fistulas). The incidence rates of postoperative delayed gastric emptying and postoperative biliary fistula were ~2.5 and 1.7%, respectively. The postoperative bleeding rate was 0.83%, and the average postoperative indwelling time of the abdominal drainage tube was 7.3 days. The postoperative length of hospital stay was 10.8 days, and the mortality rate within 90 days after surgery was 0.83%. The rates of clinically relevant postoperative clinically relevant pancreatic fistula are comparable between laparoscopic and open surgery, there were no other severe postoperative complications in either group. The mean postoperative length of hospital stay was significantly shorter in the laparoscopic pancreaticojejunostomy group.Conclusion: The modified laparoscopic-adapted Blumgart anastomosis simplifies and facilitates the creation of the pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. The rates of clinically relevant postoperative pancreatic fistula are comparable with those obtained by open surgery, and length of stay are shoter.

Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

2018 ◽  
Vol 26 (2) ◽  
pp. 201-208
Author(s):  
Mohamed El Shobary ◽  
Ayman El Nakeeb ◽  
Ahmad Sultan ◽  
Mahmoud Abd El Wahab Ali ◽  
Mohamed El Dosoky ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Postoperative Pancreatic Fistula ◽  
Tube Removal ◽  
Matched Study ◽  
The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

Central versus Distal Pancreatectomy for Benign or Low-Grade Malignant Lesions in the Pancreatic Neck and Proximal Body

2019 ◽  
Vol 85 (11) ◽  
pp. 1239-1245 ◽  
Author(s):  
Yangjun Li ◽  
Yujie Li
Keyword(s):  
Confidence Interval ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Low Grade ◽  
Exocrine Insufficiency ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.

Simplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure

2018 ◽  
Vol 84 (11) ◽  
pp. 1734-1740
Author(s):  
Michael J. Minarich ◽  
Roderich E. Schwarz
Keyword(s):  
Length Of Stay ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Oncology ◽  
Postoperative Recovery ◽  
Splenic Vessel ◽  
Pancreatic Stump ◽  
Fistula Rate ◽  
Oncology Practice ◽  
Pancreatic Fistula Rate

Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18–85 years). Underlying conditions included cancer (60%) and benign processes (40%). Resections were comprising open DP (64%), laparoscopic DP (21%), and open multivisceral resections (15%). Of 21 cases with postoperative complications (28%, no death), six were PFs (8%, 2 grade A and 4 grade B). The median length of stay was six days (4–24). The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling ( P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.

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