scholarly journals Pure Pancreaticocutaneous Fistula Shunted Into the Urinary Bladder. Lesson Learned by an Incomplete, Original Attempt

2014 ◽  
Vol 99 (3) ◽  
pp. 258-263
Author(s):  
Vincenzo Violi ◽  
Carlo Salvemini ◽  
Antonio Darecchio ◽  
Paolo Detullio ◽  
Renato Costi
Keyword(s):  
Urinary Bladder ◽  
Pancreatic Fistula ◽  
Pancreas Transplantation ◽  
Exocrine Secretion ◽  
Appropriate Technology ◽  
Modified Technique ◽  
Technical Problems ◽  
Pancreatic Remnant ◽  
Pancreatic Fistulas ◽  
Completion Pancreatectomy

Abstract Because pancreaticocystostomy is a method of exocrine secretion management in pancreas transplantation, a legitimate question is whether a pure pancreatic fistula could be shunted into the bladder. After duodenopancreatectomy for cancer, a pancreaticojejunostomy leakage was treated by pancreas-saving anastomosis disconnection. The resulting pure pancreaticocutaneous fistula was later diverted into the bladder using a Denver valved-pump device. Technical problems necessitated redoing the shunt using a modified technique and device. Although the system did work, catheter displacement outside the bladder finally caused device takedown and external fistula restoration. Our attempt did not succeed mostly because of our inexperience in dealing with an altogether novel issue without appropriate technology. Supposing its feasibility, a pancreatic-bladder shunt might have a role in treating pure pancreatic fistulas or creating an external fistula whenever the pancreatic remnant is unreliable for an anastomosis, or when a leaked anastomosis' disconnection is preferable to completion pancreatectomy.

Multidisciplinary Management of Postoperative Pancreatic Fistula

2021 ◽  
Author(s):  
Alexa Glencer ◽  
Kim Kirkwood ◽  
Adam Schwertner ◽  
Cody Keller ◽  
Mustafa Arain ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Pancreatic Fistula ◽  
Multidisciplinary Approach ◽  
Postoperative Morbidity ◽  
Postoperative Pancreatic Fistula ◽  
Significant Source ◽  
Successful Outcome ◽  
Multidisciplinary Management ◽  
Economic Strain ◽  
Pancreatic Fistulas

AbstractPostoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.

scholarly journals Pancreatic Stent Placement is Associated with Resolution of Refractory Grade C Pancreatic Fistula after Left-Sided Pancreatectomy

2009 ◽  
Vol 75 (8) ◽  
pp. 654-658 ◽  
Author(s):  
Stephen R. Grobmyer ◽  
Darrell L. Hunt ◽  
Christopher E. Forsmark ◽  
Peter V. Draganov ◽  
Kevin E. Behrns ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Median Time ◽  
Stent Placement ◽  
Morbidity And Mortality ◽  
Pancreatic Stent ◽  
Endoscopic Retrograde ◽  
Percutaneous Catheter ◽  
Pancreatic Fistulas ◽  
Fluid Collections ◽  
Operative Drainage

Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and resolve quickly with no intervention. Grade C pancreatic fistulas, which require percutaneous or operative drainage, are less common and may be associated with morbidity and mortality. We used postoperative endoscopic pancreatic stent placement as an adjunctive strategy in the management of refractory Grade C pancreatic fistulas. Patients undergoing endoscopic pancreatic stent placement for persistent, refractory peripancreatic fluid collections/pancreatic fistula after left-sided pancreatectomy were identified. Eight patients underwent endoscopic pancreatic stent placement for refractory Grade C pancreatic fistulas. Six patients had percutaneous catheter placement; two patients had trans-gastric drainage. Endoscopic retrograde cholangiopancreatography (ERCP) showed extravasation of contrast from the distal end of the pancreatic duct in seven patients. Pancreatic stents were placed in all patients at a median time of 48 days postoperation and left for a median of 47 days. Before stent removal, ERCP demonstrated pancreatic fistula closure. Median time to complete resolution of the fistula was 41 days after stent placement. Endoscopic pancreatic stents were associated with resolution of Grade C fistulas. After distal pancreatectomy, pancreatic stent placement should be considered in the postoperative period for refractory pancreatic fistulas.

Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections

2009 ◽  
Vol 75 (10) ◽  
pp. 954-957 ◽  
Author(s):  
Eduardo A. Guzman ◽  
Rebecca A Nelson ◽  
Joseph Kim ◽  
Alessio Pigazzi ◽  
Vijay Trisal ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Staple Line ◽  
Parenchymal Transection ◽  
Staple Line Reinforcement ◽  
Distal Pancreatic Resection ◽  
Pancreatic Resections ◽  
Clinicopathologic Factors ◽  
Pancreatic Fistulas ◽  
Definition Of

Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

Laparoscopic Completion Pancreatectomy for Local Recurrence in the Pancreatic Remnant after Pancreaticoduodenectomy: Case Reports and Review of the Literature

2016 ◽  
Vol 47 (4) ◽  
pp. 509-513 ◽  
Author(s):  
Mushegh A. Sahakyan ◽  
Sheraz Yaqub ◽  
Airazat M. Kazaryan ◽  
Olaug Villanger ◽  
Audun Elnæs Berstad ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Case Reports ◽  
Review Of The Literature ◽  
Pancreatic Remnant ◽  
Completion Pancreatectomy

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 Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 436-441
Author(s):  
K.G. Valikhnovska
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Retrospective Analysis ◽  
Pancreatic Head ◽  
Fistula Formation ◽  
Surgical Interventions ◽  
Periampullary Tumors ◽  
Pancreatic Fistulas

Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

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