scholarly journals Cien duodenopancreatectomías cefálicas laparoscópicas. Experiencia de dos grupos de trabajo

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Lucio Uranga ◽  
Gustavo Kohan ◽  
Luciano Bisio ◽  
Ornella Agnes Ditulio ◽  
Jorge Omar Monestés ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pancreatic Fistula ◽  
Performance Status ◽  
Technical Difficulty ◽  
Pancreatic Anastomosis ◽  
Total Hospital Stay ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Vascular Compromise ◽  
Fistula Rate ◽  
Totally Laparoscopic

Laparoscopic pancreatoduodenectomy is a challenge for the surgeon due to its technical difficulty. The learning curve is long and difficult. Objective. To show the joint experience of two surgeons in more than 100 laparoscopic pancreatoduodenectomy. Material and methods. We analysed all patients treated by laparoscopic pancreatoduodenectomy by two specialist surgeons in the period between May 2012 and May 2018. Inclusion criteria: patients with periampullary disease with indication of pancreatoduodenectomy. Exclusion criteria: patients with evident vascular compromise by images, metastatic disease or bad performance status. Results. Laparoscopic pancreatoduodenectomy was performed in 108 patients; 61 surgeries were totally laparoscopic, 35 were hybrid surgeries, and 12 were converted to open surgery. There was a significant decrease in operative time from case number 30. Twelve surgeries (11.3%) were converted. Pancreatic fistula occurred in 35 of 108 patients (32.4%). Twenty-six patients presented pancreatic fistula type A (24.1%), and 9 (8.3%) fistula B/C. The B/C fistula rate was 8.2% in laparoscopic pancreatic anastomosis, 8.6% in those reconstructed by mini-laparotomy and 8.3% in the converted patients. Reoperation was required (Dindo-Clavien 3) in 19 patients (17.5%). Mortality was 4.6% (5 patients), 2 within 30 days and 3 within 90 days. The median total hospital stay was 8.5 days (range: 4-83). Conclusion. Laparoscopic pancreatoduodenectomy is a viable and reproducible procedure that should be applied in selected cases during the learning curve, increasing its application as the number of operations carried out increases.

The outcome of laparoscopic pancreatoduodenectomy is improved with patient selection and the learning curve

2021 ◽  
Author(s):  
Safi Dokmak ◽  
Béatrice Aussilhou ◽  
Fadhel Samir Ftériche ◽  
Jeanne Dembinski ◽  
Chihebeddine Romdhani ◽  
...  
Keyword(s):  
Learning Curve ◽  
Patient Selection ◽  
Laparoscopic Pancreatoduodenectomy

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.

Long-term outcomes of pancreatic anastomosis after open and laparoscopic pancreatoduodenectomy

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S298
Author(s):  
J.S. Lee ◽  
Y. Taubabek ◽  
Y.-S. Yoon ◽  
H.-S. Han ◽  
J.Y. Cho ◽  
...  
Keyword(s):  
Long Term Outcomes ◽  
Pancreatic Anastomosis ◽  
Laparoscopic Pancreatoduodenectomy

scholarly journals The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Georgi Kalev ◽  
Christoph Marquardt ◽  
Herbert Matzke ◽  
Paul Matovu ◽  
Thomas Schiedeck
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Pancreatic Head ◽  
Suture Technique ◽  
Postoperative Pancreatic Fistula ◽  
Intermediate Care ◽  
Pancreatic Head Resection ◽  
Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

scholarly journals Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
C. Max Schmidt ◽  
Jennifer Choi ◽  
Emilie S. Powell ◽  
Constantin T. Yiannoutsos ◽  
Nicholas J. Zyromski ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Tertiary Care ◽  
High Volume ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Stenting ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Pancreatic Anastomosis ◽  
Septic Complications

Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.

Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

2016 ◽  
Vol 82 (6) ◽  
pp. 526-532 ◽  
Author(s):  
Gregory L. Peck ◽  
David N. Blitzer ◽  
Constantine S. Bulauitan ◽  
Lauren A. Huntress ◽  
Paul Truche ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Early Death ◽  
Outcome Data ◽  
Trauma Patients ◽  
Pancreatic Stump ◽  
Fibrin Sealants ◽  
Stump Closure ◽  
Pancreatic Injuries ◽  
Fistula Rate

Multiple stump closure techniques after distal pancreatectomy (DP) for trauma have been described, and all are associated with a significant fistula rate. With increasing emphasis on abbreviated laparotomy, stapled pancreatectomy has become more common. This study describes the outcomes of patients with different closure techniques of the pancreatic stump after resection following pancreatic trauma. Retrospective analysis of 50 trauma patients, who sustained grade III pancreatic injuries with subsequent DP and stapled stump closure, were conducted from 1995 to 2011. Demographic, operative, and outcome data were analyzed to characterize patients, and to directly compare closure techniques. After 12 patients were excluded because of early death (<72 hours), final analyses included 38 patients: 19 (50%) had stapled closure alone and 19 (50%) had stapling with adjunct, including additional closure with sutures, fibrin sealants, or a combination of sutures with fibrin sealants/omental coverage. Twenty-four patients (63%) had postoperative complications, most commonly pancreatic fistula (n = 11, 29%). There were no significant differences with regard to pancreatic fistula or other abdominal complications between closure groups, or were any factors associated with increased likelihood of complications. DP remains a morbid operation after trauma regardless of closure technique. Stapled closure alone is perhaps the method of choice in this setting due to the time constraints directly related to outcomes.

Central versus Distal Pancreatectomy for Benign or Low-Grade Malignant Lesions in the Pancreatic Neck and Proximal Body

2019 ◽  
Vol 85 (11) ◽  
pp. 1239-1245 ◽  
Author(s):  
Yangjun Li ◽  
Yujie Li
Keyword(s):  
Confidence Interval ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Low Grade ◽  
Exocrine Insufficiency ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.

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