scholarly journals Diagnostic criteria for a “soft” pancreas and their influence on the occurrence of pancreatic fistula after pancreatoduodenal

2020 ◽  
Vol 25 (2) ◽  
pp. 113-123
Author(s):  
Yu. S. Galchina ◽  
G. G. Kаrmаzаnovsky ◽  
D. V. Kalinin ◽  
E. V. Kondratyev ◽  
D. S. Gorin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Contrast Enhancement ◽  
Acinar Cells ◽  
Enhancement Ratio ◽  
Pancreatic Parenchyma ◽  
Duct Diameter ◽  
Clinically Significant ◽  
Parenchyma Enhancement

Purpose. Identification of the possibilities of contrast enhancement computed tomography in evaluated the number of the acinar structures in the pancreatic parenchyma at the preoperative stage to predict the development pancreatic fistula.Material and methods. In 2016–2019, 196 pancreatoduodenectomy were performed. 86 patients were retrospectively selected. Patients were divided into 2 groups: group 1 included 16 observations with the development of clinically significant pancreatic fistula, in 2 – 70 cases without complications. According to preoperative contrast enhancement computed tomography, structure of the pancreas, pancreatic parenchyma thickness, pancreatic duct diameter, the density of the pancreas in the native phase, relative parenchyma enhancement ratio, washout coefficient, pancreas stump volume were evaluated. According histological, the number of acinar and fat cells in the section of the removed pancreas was evaluated.Results. “Soft” structure of the pancreas (r = 0.374, p = 0.000), pancreatic parenchyma thickness (r = 0.549, p = 0.000), the density of the pancreas in the native phase of the scan (r = 0.568, p = 0.000), the values relative parenchyma enhancement ratio (r = 0.63, p = 0.000), pancreas stump volume (r = 0.508, p = 0.000) positively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic duct diameter (r = −0.339, p = 0.001) negatively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic fistula risk is 3.09 times higher with the number of acini more than 72.5%, sensitivity 75%, specificity 75.71%. Pancreatic fistula risk is 1.8 times higher with the density of the pancreas in the native phase over 35.5 HU sensitivity 62%, specificity 65%. Pancreatic fistula risk is 2.76 times higher with values parenchyma accumulation coefficient more than 1, sensitivity 75%, specificity 73%.Conclusions. Contrast enhancement computed tomography allows evaluating acinar index in the preoperative period to pick out the high-risk patient group to development of pancreatic fistula.

Possibility of computer tomography with contrast enhancement in evaluation of the structure of the pancreas and prediction of pancreatic fistula in pancreas resection

2020 ◽  
pp. 27-33
Author(s):  
Yulia Galchina ◽  
Gleb Galkin ◽  
Grigory Karmazanovsky ◽  
David Gorin ◽  
Andrey Kriger
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Contrast Enhancement ◽  
Postoperative Period ◽  
Arterial Phase ◽  
Preoperative Period ◽  
Duct Diameter ◽  
Soft Pancreas ◽  
Clinically Significant

One of the most common complications after pancreatic resections is an external pancreatic fistula. The main risk factor for pancreatic fistula is the “soft” structure of the pancreas. The aim of the study is to determine the possibility of computed tomography with contrast enhancement at the preoperative period in an objective assessment of the structure of the pancreas with pancreatoduodenal resections and prediction of pancreatic fistula in the postoperative period. Retrospectively, 102 patients were selected. Patients were divided into 2 groups depending on the structure of the pancreas according to computed tomography at the preoperative period. According to the data of preoperative CT with contrast enhancement, the structure of the pancreas was evaluated; density characteristics in native, arterial, venous, delayed phases (HU); pancreatic duct diameter. Group 1 included 37 patients with a “soft” pancreas. 65 patients with a “solid” pancreas were in group 2. In group 1, in 16 cases (43%), a clinically significant PF was formed in the postoperative period; in 21 cases (57%), the postoperative period proceeded uncomplicated. In group 2, in 5 cases (8%), the postoperative period was complicated by clinically significant PF; in 60 cases (92%), the postoperative period was uncomplicated. The development of clinically significant PF positively correlates with the “soft” pancreas (r = 0.374, p<0.001), the density of pancreas of the native phase (r = 0.179, p = 0.099), the density of pancreas in the arterial phase (r = 0.208, p =0.054). Negatively correlates with the “solid” pancreas (r = -0.274, p<0.001) and the pancreatic duct diameter (r = -0.339, p = 0.001). The “soft” pancreas positively correlates with the density pancreas in the native phase (r = 0,559, p<0,001) and the density pancreas in the arterial phase (r = 0,710, p<0,001) and negatively correlates with the pancreatic duct diameter (r = - 0,534, p<0,001) and the density pancreas in the excretory phase (r = -0,409, p<0,001). Using computed tomography with contrast enhancement at the preoperative period, an objective assessment of the pancreatic structure is possible due to its density characteristics in the native and arterial phases of the scan to highlight a high-risk group for the development of clinically significant PF.

Validation of Mucosal Sutureless Pancreatojejunostomy after Pancreatoduodenectomy

2014 ◽  
Vol 80 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Yoichi Ishizaki ◽  
Jiro Yoshimoto ◽  
Hiroyuki Sugo ◽  
Hiroshi Imamura ◽  
Seiji Kawasaki
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Postoperative Mortality ◽  
International Study ◽  
Study Group ◽  
International Study Group ◽  
Duct Diameter ◽  
Pancreatic Duct Stenting ◽  
Clinically Significant ◽  
Low Rate

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.

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.

scholarly journals Pancreatic Configuration Index in Predicting Postoperative Pancreatic Fistula in a Tertiary Care Center in Nepal

2020 ◽  
Vol 18 (2) ◽  
pp. 172-177
Author(s):  
Surendra Shah ◽  
Bikal Ghimire ◽  
Sharma Paudel ◽  
Yogendra Prasad Singh
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Predictive Value ◽  
Care Center ◽  
Tertiary Care ◽  
Postoperative Pancreatic Fistula ◽  
University Teaching ◽  
Female Ratio ◽  
Duct Diameter ◽  
Additional Surgery

Background: Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula.Methods: This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancreatic fistula was evaluated.Results: Among 58 patients, 9 were excluded from study and 49 patients were included in the study. The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.1:1 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%.Conclusions: Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.Keywords: Pancreaticoduodenectomy; pancreatic configuration index; postoperative pancreatic fistula.

scholarly journals Pancreatic fistula in proximal pancreas resection: correlation of computed tomography and morphological predictors

2020 ◽  
Vol 24 (1) ◽  
pp. 29-38
Author(s):  
Yu. S. Galchina ◽  
G. G. Kаrmаzаnovsky ◽  
D. V. Kalinin ◽  
E. V. Kondratyev ◽  
D. S. Gorin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Postoperative Complications ◽  
Pancreatic Fistula ◽  
Contrast Enhancement ◽  
Postoperative Period ◽  
High Risk Patient ◽  
Fat Cells ◽  
Preoperative Period ◽  
Accumulation Coefficient ◽  
Venous Phase

Purpose: identification of the possibilities of computer tomography with contrast enhancement in evaluated of the degree of fibrosis and number of acinar structures in the pancreatic parenchyma at the preoperative period to predict the development of postoperative complications.Material and methods: In the department of abdominal surgery in 2016-2019, 196 pancreatoduodenal resections were performed. Retrospectively selected group of patients (49). Patients were divided into 2 groups according with the postoperative period. The postoperative period was uncomplicated in 41 (84%) cases. Сlinically significant pancreatic fistula was in 8 (16%) cases. According to preoperative computed tomography with contrast enhancement, we evaluated: the structure of the pancreas; the density of the pancreas in the native phase of the scan (HU), parenchyma accumulation coefficient; parenchyma accumulation coefficient in the venous phase; parenchyma accumulation coefficient in the excretory phase; coefficient of relative washout of contrast enhancement of parenchyma. According histological we evaluated the number of fibrosis and acinar, fat cells in the section pancreas.Results: "Soft" structure of the pancreas (r=0,747, p=0,000), parenchyma accumulation coefficient (r=0,631, p=0,000), the density of the pancreas in the native phase of the scan (r=0,568, p=0,000) positively correlated with complicated postoperative period and the number of acinar cells. Parenchyma accumulation coefficient in the excretory phase (r=0,562, p=0,000) positively correlated with the fibrosis pancreas and in the negatively correlated with the complicated postoperative period. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient greater than 1, sensitivity 75%, specificity 73%. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient in the excretory phase less than 0.45, sensitivity 75%, specificity 63%.Conclusions: computed tomography with contrast enhancement allows the structure pancreas, the number of fibrosis and acinar cell sat the preoperative period to pick out the high-risk patient group to the development of postoperative complications.

Computed Tomography Enhancement Pattern of the Pancreatic Parenchyma Predicts Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Pancreas ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Hiromitsu Maehira ◽  
Hiroya Iida ◽  
Haruki Mori ◽  
Naomi Kitamura ◽  
Toru Miyake ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Enhancement Pattern ◽  
Pancreatic Parenchyma

scholarly journals Application Analysis of Omental Flap Isolation and Modified Pancreaticojejunostomy in Pancreaticoduodenectomy (175 Cases)

2021 ◽  
Author(s):  
Shun Deng ◽  
Jianhong Luo ◽  
Yongzhong Ouyang ◽  
Jiangbo Xie ◽  
Zhuo He ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Omental Flap ◽  
Inflammatory Factors ◽  
Greater Omentum ◽  
Control Group ◽  
Duct Diameter ◽  
Extubation Time ◽  
Group A ◽  
Group B

Abstract Background: To explore the application value of free omentum wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods: The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analyzed. All patients were divided into 86 cases in group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases in group B (control group). The incidence of pancreatic fistula and other related complications, inflammatory factors and survival rate were compared between the two groups.Results: The incidences of B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in group A were lower than those in group B, and the difference was statistically significant (P <0.05). The free omentum wrapping isolation and the modified pancreaticojejunostomy group drainage tube extubation time, open diet time and postoperative hospital stay were earlier than the control group (P <0.05). There were also statistically significant differences in CRP, IL-6, PCT inflammatory factors 1, 3, and 7 days after surgery as well as in postoperative survival rate.Univariate analysis showed that BMI, pancreatic duct diameter, greater omental flap isolation and modified pancreaticojejunostomy were related to the occurrence of pancreatic fistula after PD. Multivariate analysis showed that BMI≥24, pancreatic duct diameter less than 3mm, no greater omental flap isolation method and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P<0.05).Conclusions: Wrapping and isolating with free greater omentum plus modified pancreaticojejunostomy can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and is conducive to the prognosis.

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