Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Sanchez Bueno F ◽  
◽  
Gil Vazquez PJ ◽  
Ferreras D ◽  
Gomez B ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Randomized Study ◽  
Somatostatin Analogues ◽  
Postoperative Pancreatic Fistula ◽  
Initial Experience ◽  
Technical Success ◽  
Biodegradable Stent ◽  
Biodegradable Stents ◽  
Pancreatic Reconstruction ◽  
Pancreaticojejunal Anastomosis

Background: Postoperative Pancreatic Fistula (POPF) remains the most important morbidity after pancreaticoduodenectomy. There is no consensual technique for pancreatic reconstruction and many surgeons use a transanastomotic drain. Currently, the stents used are not degradable and they can cause obstruction, stricture and pancreatitis. The use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. The aim of the study was to evaluate technical success of implantation and safety of newly available biodegradable stents in 16 patients undergoing cephalic duodenopancreatectomy. Materials and Methods: A single-center prospective non-randomized study was conducted with patients undergoing PD. A total of 16 patients were included. A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum. Results: One of the patients developed POPF, which was successfully treated with interventional radiology drainage and somatostatin analogues. Completed degradation occurred after 3 months in all cases. There was no mortality at 30 days after PD. Conclusion: Based on our experience, the use of resorbable internal pancreatic prostheses could be a valid alternative to prevent POPF after a pancreaticoduodenectomy, also avoiding the main complications related to the use of non-absorbable prostheses.

scholarly journals USEFULNESS OF BIODEGRADABLE STENT IN THE PREVENTION OF PANCREATIC FISTULA AFTER PANCREATIC SURGERY

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
D Ferreras Martínez ◽  
P Gil Vázquez ◽  
J Egea Valenzuela ◽  
F Alberca de Las Parras ◽  
F Sánchez-Bueno
Keyword(s):  
Pancreatic Fistula ◽  
Somatostatin Analogues ◽  
Abdominal Radiograph ◽  
Correct Position ◽  
Biodegradable Stent ◽  
Drainage Fluid ◽  
Single Center Study ◽  
Stent Length ◽  
Pancreaticojejunal Anastomosis ◽  
Degradation Time

Abstract INTRODUCTION Postoperative pancreatic fistula (POPF) remains the most important cause of morbidity after cephalic pancreaticoduodenectomy (PD), affecting up to one third of cases. The aim of this paper is to present a prospective single-center study with 16 patients undergoing PD in whom a biodegradable stent was placed, analyzing morbidity and mortality, the presence of POPF and the correct position and degradation time of the stent. MATERIAL Y METHODS A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (“Archimedes”, amg International GmbH, Germany) was placed from the pancreatic duct to the jejunum (Figure 1). The stent has a helical shape that facilitates the flow of pancreatic juice. POPF was defined as drainage fluid amylase value of > 5000 U/L on the first day after surgery. RESULTS Only one patient developed POPF in the postoperative period and it was successfully treated with interventional radiology drainage and somatostatin analogues. There was no mortality at 30 days after PD. An abdominal radiograph was performed to asses well-positioning of the stent on postoperative day 7. To evaluate the degradation after three months we used the CT scan. A complete degradation was defined as < 25% of stent length or stent fragments visible at CT. Completed degradation occurred after 3 months in all cases. CONCLUSION The use of resorbable internal pancreatic stent could be a valid alternative to prevent the development of pancreatic fistula after a pancreaticoduodenectomy.

Postoperative pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy – Initial experience

Pancreatology ◽  
2013 ◽  
Vol 13 (3) ◽  
pp. S47-S48
Author(s):  
Nemanja Zaric ◽  
Ilija Pejovic ◽  
Nemanja Bidzic ◽  
Vladimir Djordjevic ◽  
Nikola Grubor ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Initial Experience

scholarly journals Modified 1-Layer Duct-to-Mucosa Pancreaticojejunostomy Reduces Pancreatic Fistula After Pancreaticoduodenectomy

2018 ◽  
Vol 103 (7-8) ◽  
pp. 378-385 ◽  
Author(s):  
Jishu Wei ◽  
Xinchun Liu ◽  
Junli Wu ◽  
Wenbin Xu ◽  
Jia Zhou ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Morbidity ◽  
Postoperative Hemorrhage ◽  
Postoperative Pancreatic Fistula ◽  
Postoperative Hospital Stay ◽  
Related Factors ◽  
Group 13 ◽  
Patient Demographics ◽  
Layer Technique ◽  
Pancreaticojejunal Anastomosis

Postoperative pancreatic fistula (POPF) is a major source of morbidity after pancreaticoduodenectomy (PD). The purpose of this retrospective study comparing 1-layer pancreaticojejunostomy (PJ) with 2-layer PJ after PD was to evaluate whether the 1-layer duct-to-mucosa PJ after PD can reduce the incidence of POPF. A total of 194 consecutive patients who underwent PD by one group of surgeons (led by Y.M.) from January 2011 to February 2014 were included in this study. Among those patients, 104 underwent 1-layer PJ (1-layer group), and 90 patients underwent 2-layer PJ (2-layer group). Preoperative clinicopathologic features, intraoperative parameters, and postoperative morbidity with a focus on POPF were compared between the 2 groups. The overall incidence of POPF was 19.6% (38 of 194 patients), and clinically relevant grade B and C POPF rates were 8.6% (16 of 194 patients) and 3.1% (6 of 194 patients), respectively. There were no differences in patient demographics and operation-related factors between the 2 groups. However, the incidence of POPF in the 1-layer group was significantly lower than in the 2-layer group [13.5% (14 of 104) of patients and 26.7% (24 of 90) of patients, respectively; P = 0.021]. The median postoperative hospital stay was also significantly shorter in the 1-layer group compared with the 2-layer group (13 versus 15 days, P = 0.035). One patient in the 2-layer group died of postoperative hemorrhage. One-layer duct-to-mucosa PJ is a simple and easy technique for pancreaticojejunal anastomosis after PD, and it can reduce the POPF rate in comparison with the 2-layer technique.

scholarly journals Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S898
Author(s):  
F. Sanchez-Bueno ◽  
D. Ferreras ◽  
P.J. Gil-Vazquez ◽  
J. Egea-Valenzuela ◽  
F. Alberca-de las Parras
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Initial Experience

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

2018 ◽  
Vol 68 (12) ◽  
pp. 2875-2878
Author(s):  
Delia Rusu Andriesi ◽  
Ana Maria Trofin ◽  
Irene Alexandra Cianga Spiridon ◽  
Corina Lupascu Ursulescu ◽  
Cristian Lupascu
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Postoperative Pancreatic Fistula ◽  
University Center ◽  
Preoperative Hemoglobin ◽  
Term Administration ◽  
Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

scholarly journals Predictive Significance of C-reactive Protein-to-albumin Ratio for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

2019 ◽  
Vol 39 (11) ◽  
pp. 6283-6290 ◽  
Author(s):  
TERUHISA SAKAMOTO ◽  
YAKUKI YAGYU ◽  
EI UCHINAKA ◽  
MASAKI MORIMOTO ◽  
TAKEHIKO HANAKI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein

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

Surgery Today ◽  
2012 ◽  
Vol 43 (2) ◽  
pp. 141-147 ◽  
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

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

BMC Surgery ◽  
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.

scholarly journals Total pancreatectomy and pancreatic fistula: friend or foe?

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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