scholarly journals Three Steps for a Safe Pancreaticoduodenectomy: Neither Pancreatic Texture nor Duct Size Matters

2017 ◽  
Vol 01 (01) ◽  
Author(s):  
Yu-Chung Chang
Keyword(s):  
Pancreatic Texture

scholarly journals Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture 

2020 ◽  
Author(s):  
Gozo Kiguchi ◽  
Atsushi Sugioka ◽  
Masaya Nakauchi ◽  
Masayuki Kojima ◽  
Akira Yasuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Texture ◽  
Technical Issues ◽  
Fistula Rate ◽  
Robotic Pancreaticoduodenectomy ◽  
Open Pancreaticoduodenectomy

Abstract Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.

scholarly journals A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively

HPB ◽  
2010 ◽  
Vol 12 (10) ◽  
pp. 696-702 ◽  
Author(s):  
Ulrich Friedrich Wellner ◽  
Gian Kayser ◽  
Hryhoriy Lapshyn ◽  
Olivia Sick ◽  
Frank Makowiec ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Scoring System ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Factors ◽  
Pancreatic Texture

Pancreatic texture study (PaTeSt). Preliminary results of intraoperative elastic module measurement

Pancreatology ◽  
2012 ◽  
Vol 12 (6) ◽  
pp. 542-543
Author(s):  
G. Marchegiani ◽  
G. Malleo ◽  
M. Paini ◽  
R. Ballarin ◽  
P. Capelli ◽  
...  
Keyword(s):  
Preliminary Results ◽  
Elastic Module ◽  
Pancreatic Texture

scholarly journals No Mortality or Pancreatic Fistula After Full-Thickness Suture Pancreaticogastrostomy in 39 Patients Who Underwent Pancreaticoduodenectomy

2015 ◽  
Vol 100 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Ozdemir Fatih ◽  
Baskiran Adil ◽  
Ara Cengiz ◽  
Ates Mustafa ◽  
Kahraman Ayşegul Sagir ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Morbidity And Mortality ◽  
Full Thickness ◽  
Safe Method ◽  
Standard Operation ◽  
Duct Diameter ◽  
Periampullary Tumors ◽  
Pancreatic Texture

Pancreaticoduodenectomy is considered the standard operation for periampullary tumors. Despite major advances in pancreatic surgery, pancreatic fistula is still an important cause of morbidity and mortality after pancreaticoduodenectomy. Meticulous surgical technique and proper reconstruction of the pancreas are essential to prevent pancreatic fistula. Pancreaticogastrostomy is a safe method for reconstruction of the pancreas after pancreaticoduodenectomy. Regardless of pancreatic texture or duct diameter, the reconstruction is performed by passing full-thickness sutures through both the anterior and posterior sides of the pancreas. In this study, we report 39 cases of reconstruction with pancreaticogastrostomy after pancreaticoduodenectomy without mortality or pancreatic fistula.

Quantitative Assessment of Pancreatic Texture Using a Durometer: A New Tool to Predict the Risk of Developing a Postoperative Fistula

2017 ◽  
Vol 41 (11) ◽  
pp. 2876-2883 ◽  
Author(s):  
Giovanni Marchegiani ◽  
Roberto Ballarin ◽  
Giuseppe Malleo ◽  
Stefano Andrianello ◽  
Valentina Allegrini ◽  
...  
Keyword(s):  
Quantitative Assessment ◽  
Postoperative Fistula ◽  
Pancreatic Texture

scholarly journals The Individualized Selection of Pancreaticoenteric Anastomosis in Pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke-Min Jin ◽  
Wei Liu ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Operation Time ◽  
Postoperative Management ◽  
Postoperative Pancreatic Fistula ◽  
Drainage Fluid ◽  
Soft Pancreas ◽  
Pancreatic Texture ◽  
The Impact

Abstract Background: The mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved. The present study aimed to clarify the impact of individualized pancreaticoenteric anastomosis and management to postoperative pancreatic fistula.Methods: Data from 529 consecutive pancreaticoduodenectomies were retrospectively analysed from the Hepatobiliary and Pancreatic Surgery Unit I, Peking Cancer Hospital. The pancreaticoenteric anastomosis was determined based on the pancreatic texture and diameter of the main pancreatic duct. The amylase value of the drainage fluid was dynamically monitored postoperatively on days 3, 5 and 7. A low speed intermittent irrigation was performed in selected patients. Intraoperative and postoperative results were collected and compared between the pancreaticogastrostomy (PG) group and pancreaticojejunostomy (PJ) group.Results: From 2010 to 2019, 529 consecutive patients underwent pancreaticoduodenectomy. Pancreaticogastrostomy was performed in 364 patients; pancreaticojejunostomy was performed in 150 patients respectively. The clinically relevant pancreatic fistula (CR-POPF) was 9.8% and mortality was zero. The soft pancreas, diameter of main pancreatic duct≤3mm, BMI≥25, operation time>330min and pancreaticogastrostomy was correlated with postoperative pancreatic fistula significantly. The CR-POPF of PJ was significantly higher than that of PG in soft pancreas patients; the operation time of PJ was shorter than that of PG significantly in hard pancreas patients. Intraoperative blood loss and operation time of PG was less than that of PJ significantly in normal pancreatic duct patients (p<0.05).Conclusions: Individualized pancreaticoenteric anastomosis should be determined based on the pancreatic texture and pancreatic duct diameter. The appropriate anastomosis and postoperative management could prevent mortality.

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