Risk Factors of Pancreatic leakage AfterWhipple’s Procedure

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Elshamy ◽  
A S El-Sobky ◽  
S A Ahmed ◽  
S M Mansour
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
University Hospitals ◽  
Pancreatic Anastomosis ◽  
Pancreatic Leakage ◽  
Pancreatic Remnant ◽  
Soft Pancreas ◽  
Whipple’S Procedure ◽  
Pancreatic Reconstruction ◽  
A Prospective Study

Abstract Background Pancreaticoduedenectomy is the operative of choice in cases of resectable tumors of the periampullary region. Critical step in pancreatic surgery is no longer the resection itself but the reconstruction of the pancreaticoenteric anastomosis. Different methods of pancreatic reconstruction have been proposed aiming to limit the rate of leakage of pancreatic anastomosis. Aim of the Work to evaluate the risk factors of pancreatic remnant leakage after Whipple’s procedure as regards risk factors of the diameter of the pancereatic duct and the texture of the pancereatic remnant during operation (soft or firm). Patients and Methods A prospective study conducted on 30 patients who underwent pancreaticoduodenectomy in Ain Shams University Hospitals during the period from June 2012 to June 2018 to evaluate the risk factors of pancreatic leakage after Whipple’s procedure regarding pancreatic duct diameter and pancreatic remnant texture. Results 60% of leakage group had soft pancreas and narrow pancreatic duct less than 3mm, while 40% of non leakage group had soft pancreas and narrow pancreatic duct less than 3mm. Conclusion strong correlation between postoperative pancreatic leakage and narrow pancreatic duct as well as soft pancreas. Statistics proved that correlation and also, the relation of high mortality rate among those who developed postoperative pancreatic fistula.

scholarly journals Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

2021 ◽  
Vol 8 ◽  
Author(s):  
Antonio Giuliani ◽  
Pasquale Avella ◽  
Anna Lucia Segreto ◽  
Maria Lucia Izzo ◽  
Antonio Buondonno ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Postoperative Outcomes ◽  
Cyanoacrylate Glue ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
The Mean

Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed–pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)–none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO.Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months.Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221–480 min). Hospital stay was significantly longer in patients who developed POPF (p < 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III–IV. At the last follow-up, 27 of the 31 (87%) patients were alive.Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.

scholarly journals Unconventional Technique of Terminolateral Pancreatojejunostomy Formation

2021 ◽  
Vol 14 (1) ◽  
pp. 25-32
Author(s):  
Badri Valerievich SiguA ◽  
Vyacheslav Petrovich Zemlyanoy ◽  
Evgeny Alekseevich Zakharov ◽  
Malkhaz Yurievich Tsikoridze ◽  
Anatoliy Nikolaevich Napalkov
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Main Group ◽  
Soft Pancreas ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Novel Method

Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct ( 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p 0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p 0.05).Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

SFO-1 and DHA-1 genes Detection in β-lactamases-producing Klebsiella pneumoniae Causing Blood Stream Infections Acquired in Intensive Care Units in Mansoura University Hospitals

2021 ◽  
Vol 30 (3) ◽  
pp. 43-51
Author(s):  
Nermeen Nassar ◽  
Mohammad Badr ◽  
Nehad Nasef ◽  
Ghada Barakat
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Blood Stream ◽  
Clinical Samples ◽  
University Hospitals ◽  
Blood Stream Infections ◽  
Significant Difference ◽  
Synergy Test ◽  
A Prospective Study ◽  
Low Prevalence

Objectives: The study aimed to detect SFO-1 and DHA-1 genes and to differentiate AmpC with overlapped ESBL isolates. Also, it identified the risk factors aiding in emergence the ESBL producing K.pneumoniae causing blood stream infections in ICUs of Mansoura University Hospitals (MUHs). Methodology: This is a prospective study that enrolled 520 blood samples. Double disk synergy test (DDST) and Modified threedimensional test were performed. Genotypic detection of SFO-1, Class A ESBL, and DHA-1, AmpC β-lactamase was done. Results: 520 septicemic patients were enrolled with significant correlation for adults’ acquisition of infection. The main bacteria isolates causing nosocomial infection in septicemic patients admitted to ICU were S. aureus, E. coli and K. pneumoniae. A significant difference in distribution of ESBL and AmpC β-lactamases was detected with significant association between impenem resistance and prevalence of ESBL in those patients. There was a low-occurrence of ESBL SFO-1 and DHA-1 detected in clinical samples. Surgical intervention and CVC were the significant risk factors for presence of ESBL but previous antibiotics and hospital stay were non-significant effectors for presence of ESBL. Conclusion: Though SFO-1 is a low-prevalence ESBL, it has been taken by a plasmid with many other multiple resistance determinants including many related genes, and go together with by a large DHA-1- plasmid.

scholarly journals A Simple, Secure and Universal Pancreaticojejunostomy following Pancreaticoduodenectomy

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 305-310 ◽  
Author(s):  
P.-W. Lin ◽  
J.-C. Lee ◽  
P.-C. Lee ◽  
T.-W. Chang ◽  
C.-J. Hung ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pancreatic Duct ◽  
Operative Mortality ◽  
Operating Time ◽  
Whipple Procedure ◽  
Pancreatic Ducts ◽  
Intraoperative Blood Loss ◽  
Pancreatic Anastomosis ◽  
Pancreatic Remnant ◽  
Pancreaticojejunal Anastomosis

Although the operative mortality of pancreaticoduodenal resection has decreased recently, the operative morbidity resulting from a leaking pancreatic anastomosis remains high. We described our experience in 50 consecutive cases with a simple, secure end to side pancreaticojejunostomy. We used a paediatric nasogastric tube in the pancreatic remnant duct as a temporary external pancreatic drain. There were 29 men and 21 women ranging from 12 to 84 years with a median age of 61 years. Forty-two patients underwent a standard Whipple procedure and eight a pylorus preserving pancreaticoduodenectomy. Average operating time was 270 minutes with a range of 170 to 480 minutes. The pancreaticojejunostomy could be constructed in a mean of 8 minutes. Intraoperative blood loss ranged from 150 to 3500 mL with a mean of 910mL. Twenty-five patients (50 %) received no blood transfusion. The consistency of the pancreatic remnant was hard in 12 patients (24 %) and normal in 38 patients (76 %). The pancreatic duct was dilated (>4mm) in 15 patients (30 %). There was no operative mortality and only three (6.0 %) minor leaks from the pancreatic anastomosis which healed spontaneously. It was difficult to determine if the leaks were related to the consistency of the pancreatic remnant, the size of the pancreatic duct, the amount of intraoperative blood loss, operating time, sex of the patient or experience of the surgeon, as there were only three leaks. We concluded that our technique for pancreaticojejunal anastomosis following pancreaticoduodenectomy was safe and applicable to, standard Whipple or pylorus preserving pancreaticoduodenectomy, small or dilated pancreatic ducts, normal or fibrotic pancreas.

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

2020 ◽  
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

AbstractClinically 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 discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. 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 are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant

1997 ◽  
Vol 185 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Mark I.van Berge Henegouwen ◽  
Laurens Th De Wit ◽  
Thomas M.Van Gulik ◽  
Huug Obertop ◽  
Dirk J Gouma
Keyword(s):  
Risk Factors ◽  
Pancreatic Leakage ◽  
Pancreatic Remnant ◽  
Incidence Risk
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