Efficacy of Distal Pancreatectomy Combined With Modified DuVal Procedure in Patients With a High Risk of Postoperative Pancreatic Fistula

Background The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. The present study aimed to clarify the efficacy of our modified DuVal (mDuVal) pancreatojejunostomy following DP in patients with a high risk of POPF. Methods The medical records of 346 consecutive patients who underwent DP between 2006 and 2016 were retrospectively reviewed. Perioperative features were compared between 24 patients undergoing mDuVal (mDuVal group) and 322 patients undergoing standard DP (standard DP group). Results Preoperative American Society of Anesthesiologists physical status 1 was more frequent in the standard group than in the mDuVal group ( P = .02). The start of a solid diet after operation was significantly earlier in the mDuVal group than in the standard DP group ( P = .01), while there were no significant differences between the groups for clinically relevant POPF, amylase concentration in the drainage fluid on postoperative day 1 and days 3-5, time to drain removal, additional intervention for POPF, overall complications, or postoperative hospital stay. Discussion The mDuVal procedure could be an option for patients with a high risk of POPF to improve the outcomes after DP. Further investigation involving large study populations is necessary to clarify the efficacy of this procedure.

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Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler

Surgery Today ◽

10.1007/s00595-012-0235-4 ◽

2012 ◽

Vol 43 (2) ◽

pp. 141-147 ◽

Cited By ~ 34

Author(s):

Keiichi Okano ◽

Minoru Oshima ◽

Keitaro Kakinoki ◽

Naoki Yamamoto ◽

Shintaro Akamoto ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factor ◽

Postoperative Pancreatic Fistula ◽

Pancreatic Thickness

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Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽

10.1186/s12893-020-00968-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Runwen Liu ◽

Yunqiang Cai ◽

He Cai ◽

Yajia Lan ◽

Lingwei Meng ◽

...

Keyword(s):

Prediction Model ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Laparoscopic Pancreaticoduodenectomy ◽

C Reactive Protein ◽

Dynamic Prediction ◽

Albumin Ratio ◽

Drainage Fluid ◽

Reactive Protein ◽

Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

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Total pancreatectomy and pancreatic fistula: friend or foe?

Updates in Surgery ◽

10.1007/s13304-021-01130-3 ◽

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.

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Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

Anesthesiology ◽

10.1097/aln.0b013e31816d91b5 ◽

2008 ◽

Vol 108 (5) ◽

pp. 822-830 ◽

Cited By ~ 302

Author(s):

Frances Chung ◽

Balaji Yegneswaran ◽

Pu Liao ◽

Sharon A. Chung ◽

Santhira Vairavanathan ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

High Risk ◽

Screening Tools ◽

Surgical Patients ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Obstructive Sleep ◽

American Society ◽

American Society Of Anesthesiologists ◽

Stop Questionnaire

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

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Use of a Reinforced Triple-row Stapler Following Distal Pancreatectomy Reduces the Incidence of Postoperative Pancreatic Fistula in Patients With a High BMI

Anticancer Research ◽

10.21873/anticanres.13207 ◽

2019 ◽

Vol 39 (2) ◽

pp. 1013-1018 ◽

Cited By ~ 2

Author(s):

HIROMICHI KAWAIDA ◽

HIROSHI KONO ◽

HIDETAKE AMEMIYA ◽

NAOHIRO HOSOMURA ◽

RYO SAITO ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

High Bmi

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Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection

The American Surgeon ◽

10.1177/000313481808400138 ◽

2018 ◽

Vol 84 (1) ◽

pp. 149-153 ◽

Cited By ~ 1

Author(s):

Takao Ohtsuka ◽

Yasuhisa Mori ◽

Takaaki Fujimoto ◽

Yoshihiro Miyasaka ◽

Kohei Nakata ◽

...

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Pancreatic Resection ◽

Medical Records ◽

Operation Time ◽

Postoperative Pancreatic Fistula ◽

Postoperative Hospital Stay ◽

High Risk Patients ◽

Risk Patients ◽

Related Mortality

The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with ( n = 10) and without ( n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer ( P < 0.01) and blood loss significantly greater ( P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent ( P = 0.02) and postoperative hospital stay was significantly longer ( P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.

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