scholarly journals Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection

2019 ◽  
Vol 147 (7-8) ◽  
pp. 484-487
Author(s):  
Mariusz Chabowski ◽  
Wiktor Pawlowski ◽  
Michał Lesniak ◽  
Agnieszka Ziomek ◽  
Maciej Malinowski ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Gastrointestinal Stromal Tumor ◽  
Pancreatic Fistula ◽  
Pancreatic Secretion ◽  
Postoperative Pancreatic Fistula ◽  
Stromal Tumor ◽  
Fistula Formation ◽  
Clinical State ◽  
Amylase Level ◽  
Clinical Awareness

Introduction. According to the International Study Group on Pancreatic Fistula, a postoperative pancreatic fistula is defined as every case of fluid leak on the third (or later) postoperative day, in which the level of amylase in the collected fluid is at least three times higher than the serum amylase level. Depending on the stage and the designated management, pancreatic fistulas are divided into the following three categories: A (mild), B, and C (severe). Regardless of favorable conditions, exocrine pancreatic secretion is the key factor in fistula formation. The decrease in pancreatic secretion caused by somatostatin and its analogues combined with parenteral nutrition is a well-established treatment method in pancreatic fistula management. Case outline. The case of a 69-year-old patient who had undergone a resection of a duodenal gastrointestinal stromal tumor located directly above the major duodenal papilla is presented. Excessive drainage of amylase-rich fluid was observed in the postoperative period. Treatment comprised continuous infusion of somatostatin and parenteral nutrition. Fistula closure was accomplished on postoperative day 14, confirmed by a radical decrease in the volume of drainage and low amylase levels in the collected fluid. The patient remained in a good clinical state and was discharged from hospital on postoperative day 20. Conclusion. This is an example of the early diagnosis of a postoperative pancreatic fistula, treated conservatively with the use of somatostatin. Post-surgery clinical awareness of the importance of direct contact between the stromal tumor and pancreatic tissues, in connection with routine amylase level assessment, led to a quick diagnosis of pancreatic fistula and the therapy led to an uneventful outcome.

scholarly journals To Study the Biochemical Markers for the Prediction of Fistula Formation after Pancreatic Resection Surgery in the Post Operative Period

2021 ◽  
Vol 3 (2) ◽  
pp. 33-39
Author(s):  
SA Mir ◽  
S. Akhter ◽  
S. S. Ahmad ◽  
S. H. Altaf ◽  
J. Ahmad ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Serum Amylase ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Amylase Level ◽  
Medical Procedure ◽  
Serum Amylase Level ◽  
Post Operation ◽  
Laboratory Biomarkers

Background: To study and assess the potential laboratory biomarkers for foreseeing postoperative pancreatic fistula (POPF) after pancreatic resection medical procedures. Subjects and Methods: 64 patients were studied from Jan 2008 to Dec 2018. All patients undergoing Pancreatic resection surgeries like Pancreaticoduodenectomy (PD), distal Pancreatectomy (DP) for tumors of the periampullary region, Pancreatic body or chronic pancreatitis Clinical data of the patients, surgical approach, pancreatic parenchymal tissue consistency, histopathology of the specimen, white blood cell count and blood amylase levels tube Drain fluid amylase were recorded and analyzed. Correlations between these parameters and postoperative pancreatic fistula (POPF) were assessed. Results : 22 out of the 64 (34.37%) patients developed POPF. The fistula was graded according to the ISPG classification. It was Grade An of every 10 (45.45%) patients, grade B in 8 (36.36%), and grade C in 4 (18.18%),.On univariate and multivariate strategic relapse investigations, higher amylase levels in the stomach waste liquid on a postoperative day (POD)1 and higher serum amylase levels on POD4 indicated a critical relationship with fistula arrangement in the post-operation period (POPF) (P < 0.05). On ROC (recipient working trademark bend) examination, amylase cut-off degree of 2270.67 U/L in the stomach waste liquid was related with a 76.6% affectability and 82% particularity [area under the bend (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 53.2 U/L was related with a 74.6% affectability and 72.9% explicitness (AUC: 0.784; P = 0.05). Conclusion: Post-operative channel liquid amylase levels on day 1 and serum amylase level on day 4 speak to interesting biomarkers related to POPF improvement after the pancreatic medical procedure.

scholarly journals Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jun Kinoshita ◽  
Takahisa Yamaguchi ◽  
Hiroto Saito ◽  
Hideki Moriyama ◽  
Mari Shimada ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Pancreatic Fistula ◽  
Left Gastric Artery ◽  
Postoperative Pancreatic Fistula ◽  
Open Gastrectomy ◽  
Amylase Level ◽  
Prognostic Impact ◽  
Anatomic Location ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

scholarly journals Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

2020 ◽  
Author(s):  
Jun Kinoshita ◽  
Takahisa Yamaguchi ◽  
Hiroto Saito ◽  
Hideki Moriyama ◽  
Mari Shimada ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Pancreatic Fistula ◽  
Left Gastric Artery ◽  
Postoperative Pancreatic Fistula ◽  
Open Gastrectomy ◽  
Amylase Level ◽  
Prognostic Impact ◽  
Anatomic Location ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Background: Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods: In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results: Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p=0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P=0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P=0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P=0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions: The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

scholarly journals Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy

HPB Surgery ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Fritz Klein ◽  
Igor Maximilian Sauer ◽  
Johann Pratschke ◽  
Marcus Bahra
Keyword(s):  
Bovine Serum Albumin ◽  
Serum Albumin ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Bovine Serum ◽  
Postoperative Mortality ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Pancreatic Remnant ◽  
The Impact

Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

scholarly journals Preoperative radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S178-S179
Author(s):  
E.W. Box ◽  
D.E. Morgan ◽  
L. Deng ◽  
R. Xie ◽  
J.K. Kirlin ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Radiographic Measurements

Early Drain Removal Regardless of Drain Fluid Amylase Level Might Reduce Risk of Postoperative Pancreatic Fistula

2021 ◽  
Vol 41 (1) ◽  
pp. 403-408
Author(s):  
HIROMICHI KAWAIDA ◽  
HIROSHI KONO ◽  
HIDETAKE AMEMIYA ◽  
NAOHIRO HOSOMURA ◽  
YUDAI HIGUCHI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Drain Removal ◽  
Drain Fluid ◽  
Reduce Risk

Pancreatic Chymotrypsin Activity Rather Than Amylase Level Better Predicts Postoperative Pancreatic Fistula

2017 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Suguru Yamashita ◽  
Takeaki Ishizawa ◽  
Kazuhiro Mori ◽  
Kazuteru Monden ◽  
Yugo Kuriki ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Chymotrypsin Activity

scholarly journals Total Amylase Value in Drains After Gastrectomy for Predicting Postoperative Pancreatic Fistula

2020 ◽  
Author(s):  
Toshitaka Sugawara ◽  
Hisashi Shinohara ◽  
Shusuke Haruta ◽  
Junichi Shindo ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Concentration Ratio ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Roc Curves ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Anastomotic Site ◽  
Drainage Fluid

Objective: Postoperative pancreatic fistula (POPF) is defined using the ratio of the bilirubin concentration in abdominal drainage fluid to the upper normal range of serum amylase level. However, we hypothesized that the total amylase value in discharge (AVD) on POD 3 may be more sensitive for predicting grade II or higher severe POPF sPOPF, and compared the predictive power of the conventional definition of POPF and AVD for sPOPF. Methods: One hundred and fifty-one patients who underwent gastrectomy between October 2011 and February 2013 were analyzed. A drainage tube was placed in all the cases through the stump of the right gastroepiploic vein and the front of the pancreas to the back of the anastomotic site. The drainage volume and amylase concentration in the discharge were examined on POD 1, 3, and 5. AVD was calculated by multiplying the volume by the amylase concentration. Results: Eight patients (5.3%) developed sPOPF. In univariate analysis, both AVD and the amylase concentration ratio was significantly correlated with sPOPF (P = 0.002 and 0.007, respectively). AVD on POD 3 showed the best predictive performance compared with the amylase concentration ratio on POD 3 (area under the curve 0.876 vs. 0.844). Based on the cutoff values calculated from the ROC curves, AVD was more specific than amylase concentration ratio in predicting sPOPF (specificity: 97.6% vs. 86.0%; PPV: 62.5% vs. 23.1%). Conclusion: AVD on POD 3 is a more specific parameter than conventional amylase concentration ratio in predicting sPOPF.

scholarly journals Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Amyna Jiwani ◽  
Tabish Chawla
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
Multivisceral Resection ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Fistula Formation ◽  
Factors Associated

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

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