Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy

2016 ◽  
Vol 101 (11-12) ◽  
pp. 550-553
Author(s):  
Ippei Matsumoto ◽  
Keiko Kamei ◽  
Shumpei Satoi ◽  
Takuya Nakai ◽  
Yoshifumi Takeyama
Keyword(s):  
Portal Vein ◽  
Pancreatic Fistula ◽  
Dorsal Surface ◽  
Uncinate Process ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Annular Pancreas ◽  
Exocrine Function ◽  
Portal Annular Pancreas ◽  
Increased Risk

Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.

scholarly journals Portal annular pancreas

2018 ◽  
Vol 23 (3) ◽  
pp. 64-68
Author(s):  
E. A. Akhtanin ◽  
A. A. Goev ◽  
P. I. Davydenko ◽  
A. G. Kriger
Keyword(s):  
Portal Vein ◽  
Clinical Observation ◽  
Pancreatic Head ◽  
Annular Pancreas ◽  
Head Cancer ◽  
Pancreatic Head Cancer ◽  
Portal Annular Pancreas

The clinical observation of a patient with pancreatic head cancer and intrapancreatic location of the portal vein is described. Surgical features of pancreatoduodenectomy, intraoperative complexities due to portal vein localization are comprehensively presented. Literature data are reviewed.

A patient with a neuroendocrine tumor of the pancreatic uncinate process with portal annular pancreas

Suizo ◽  
2021 ◽  
Vol 36 (2) ◽  
pp. 128-134
Author(s):  
Daisuke SHIRAI ◽  
Akihiro MURATA ◽  
Sadatoshi SHIMIZU ◽  
Shintaro KODAI ◽  
Kotaro MIURA ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Uncinate Process ◽  
Annular Pancreas ◽  
Portal Annular Pancreas

scholarly journals Surgical glance at pancreatic arterial anatomy

2021 ◽  
Vol 26 (3) ◽  
pp. 112-122
Author(s):  
A. G. Kriger ◽  
N. A. Pronin ◽  
M. V. Dvukhzhilov ◽  
D. S. Gorin ◽  
A. V. Pavlov ◽  
...  
Keyword(s):  
Portal Vein ◽  
Pancreatic Fistula ◽  
Computer Tomography ◽  
Mesenteric Artery ◽  
Splenic Artery ◽  
Postoperative Pancreatic Fistula ◽  
Gastroduodenal Artery ◽  
Dorsal Pancreatic Artery ◽  
Pancreatic Artery ◽  
Arterial Anatomy

Aim. Study of anatomical variations of the pancreatic neck blood supply, which may affect the results of pancreaticoduodenectomy.Material and methods. Anatomic characteristics of arterial blood supply of pancreas were studied in 42 autopsied cases, who died from diseases not associated with abdominal organs failure. Clinical part of our study included 62 patients. Arterial anatomy was examined during early arterial phase of computer tomography. Options of the origin of the dorsa pancreatic artery were noted. All patients had “soft” pancreas confirmed by morphological examination and computer tomography. Main group included 20 patients. Dissection of the pancreas during pancreatoduodenectomy in this group were performed 10–15 mm left of portal vein confluence. Control (retrospective) group included 42 patients performed standard procedure, when pancreas was dissected above the portal vein confluence.Results. It was found that the neck of pancreas was supplied from dorsal pancreatic artery, found in all specimens. In 76% of cases it was a branch of splenic artery, in other cases – a branch of superior mesenteric artery. CT scan revealed the dorsal pancreatic artery in 54 (87.1%) people, in 8 patients the artery could not be identified. The dorsal pancreatic artery was a branch of the splenic artery in 64.8% of cases. In other cases it was a branch of the superior mesenteric artery, common hepatic artery, gastroduodenal artery and middle colon artery. If the dorsal pancreatic artery was a branch of the superior mesenteric, common hepatic, gastroduodenal artery, it was transected during lymphadenectomy. This led to higher frequency of postoperative pancreatic fistula.Conclusion. Localization of dorsal pancreatic artery must be taken into account during the pancreatoduodenectomy. That allows to decrease probability of postoperative pancreatic fistula.

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.

scholarly journals The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 126
Author(s):  
Hao-Wei Kou ◽  
Chih-Po Hsu ◽  
Yi-Fu Chen ◽  
Jen-Fu Huang ◽  
Shih-Chun Chang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Predictive Factors ◽  
Biliary Drainage ◽  
Financial Burden ◽  
Failure To Thrive ◽  
Postoperative Recovery ◽  
Postoperative Pancreatic Fistula ◽  
Increased Risk ◽  
Study Characteristics ◽  
Unplanned Visit

Background: Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. Methods: We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. Results: The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. Conclusions: UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.

scholarly journals Portal Annular Pancreas with portal cavernoma formation wtih associated dorsal pancreatic agenesis-A rare case report

2019 ◽  
Vol 2 (1) ◽  
pp. 01-03
Author(s):  
Lokesh Rana
Keyword(s):  
Case Report ◽  
Portal Vein ◽  
Rare Case ◽  
Pancreatic Tissue ◽  
Annular Pancreas ◽  
Portal Annular Pancreas ◽  
Luminal Narrowing ◽  
Portal Cavernoma ◽  
Rare Case Report ◽  
Pancreatic Agenesis

Portal annular pancreas is a uncommon congenital anomaly resulting from fusion of the pancreatic parenchyma around the portal vein. Its causing portal cavernoma formation and association with dorsal pancreatic agenesis is rare Case report We report a 51-year-old female who underwent contrast enhanced computed tomography for vague right hypochndrial pain.On CECT abdomen images there was presence of rind of pancreatic tissue around the portal vein causin its luminal narrowing with proximal dilation of portal vein tributaries with cavernoma formation.There was also presence of agenesis of dorsal pancreas in this patient.Conclusion This variant of portal annular pancreas with cavernoma formation associated with dorsal pancreatic agenesis has not yet been reported and we propose a new CT classification of the same.

Preoperative pancreatic duct stenting in patients undergoing laparoscopic pancreatic surgery – a preliminary report

2015 ◽  
Vol 87 (6) ◽  
Author(s):  
Mateusz Rubinkiewicz ◽  
Marcin Migaczewski ◽  
Michał Pędziwiatr ◽  
Maciej Matłok ◽  
Marcin Dembiński ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Resection ◽  
Pancreatic Surgery ◽  
Uncinate Process ◽  
The Body ◽  
Open Approach ◽  
Laparoscopic Pancreatic Surgery ◽  
Pancreatic Duct Stenting ◽  
Laparoscopic Pancreatic Resection

AbstractLaparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum.The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery.Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery.Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery.Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.

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