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Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

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Hepatobiliary & Pancreatic Diseases International 2012年第1期11卷 89-95页

作者： Fritz Klein Marcus Bahra Matthias Glanemann Wladimir Faber Peter Warnick Andreas Andreou Safak Gül Dietmar Jacob Department of General Visceraland Transplantation SurgeryCharité-Campus VirchowUniversit tsmedizin Berlin Department of Visceral Vascularand Minimally Invasive SurgeryVivantes Klinikum Spandau

BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue *** 'gold standard' surgical technique for pancreaticoenteric anastomosis has been *** study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress ***:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric *** with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were *** groups were homogeneous for age,gender,and underlying *** morbidity,mortality,and preoperative and operative data were ***:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the *** age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative ***:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue *** our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomos

关键词： mattress sutures pancreaticoduodenectomy pancreaticogastrostomy pancreaticojejunostomy soft pancreatic tissue remnant

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Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent

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World Journal of Clinical Cases 2016年第4期4卷 112-117页

作者： Arunchai Chang Pitulak Aswakul Varayu Prachayakul Siriraj Gastrointestinal Endoscopy Center Division of Gastroenterology Department of Internal Medicine Siriraj Hospital Faculty of Medicine Mahidol University Liver and Digestive Institute Samitivej Sukhumvit Hospital

One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type *** of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches,ranging from pharmacologic,endoscopic and radiologic treatments to surgical *** the conservative treatment approaches fail to resolve symptomatic cases,however,endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach,despite its well-recognized *** the conventional transpapillary approach fails to achieve the necessary drainage,the patients may benefit from application of the less invasive endoscopic ultrasound(EUS)-guided pancreatic duct ***,we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 *** tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at *** conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms,EUS-guided pancreaticogastrostomy(PGS)was applied using a fully covered,self-expandable,10-mm diameter metallic *** treatment resolved the case and the patient experienced no adverse ***-guided PGS with a regular biliary fully covered,self-expandable metallic stent effectively and safely treated pancreatictype pain in chronic pancreatitis.

关键词： Endoscopic ultrasound-guided Endoscopic ultrasound pancreaticogastrostomy Pancreatic duct drainage Chronic pancreatitis Self-expandable metallic stent

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Applying refined pancreaticogastrostomy techniques in pancreatic trauma

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 521-524页

作者： Jake Krige Marc Bernon Eduard Jonas Department of Surgery University of Cape Town Health Sciences FacultyCape Town 7925South Africa

We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreaticogastrostomy(PG)or a control group with a routine mucosa-to-mucosa *** six months anastomoses had strictured and closed in both *** authors concluded that“bridging”PG is feasible and safe in damage control surgery during the early stage of pancreatic *** this letter we comment on the study design,specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma *** data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.

关键词： Pancreatic trauma Pancreatic anastomoses pancreaticogastrostomy Complications

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Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 528-536页

作者： Ayman El Nakeeb Ahmad M Sultan Ehab Atef Ali Salem Mostaffa Abu Zeid Ahmed Abu El Eneen Gamal El Ebidy Mohamed Abdel Wahab Gastroenterology Surgical Center Mansoura UniversityMansoura 35516 Egypt

BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy(PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula(POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of *** study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group(absent risk factor), moderate-risk group(presence of one risk factor) and high-risk group(presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m~2, cirrhotic liver, soft pancreas, pancreatic duct diameter pancreaticogastrostomy(PG) in high-risk group, while pancreaticojejunostomy(PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in l

关键词： periampullary tumor pancreaticogastrostomy pancreaticojejunostomy pancreaticoduodenectomy postoperative pancreatic fistula

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Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases

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World Journal of Gastroenterology 2017年第38期23卷 7025-7036页

作者： ayman el nakeeb waleed askar ehab atef ehab el hanafy ahmad m sultan tarek salah ahmed shehta mohamed el sorogy emad hamdy mohamed el hemly ahmed a el-geidi tharwat kandil mohamed el shobari talaat abd allah amgad fouad mostafa abu zeid ahmed abu el eneen nabil gad el-hak gamal el ebidy omar fathy ahmed sultan mohamed abdel wahab gastroenterology surgical center mansoura university

AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PDs) for periampullary *** This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period(1993-2002), middle period(2003-2012), and late period(2013-2017).RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the *** Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.

关键词： Pancreaticoduodenectomy pancreaticogastrostomy Pancreaticojejunostomy Postoperative pancreatic fistula Periampullary tumor

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Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: An updated meta-analysis of RCTs and our experience

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World Journal of Gastrointestinal Surgery 2019年第7期11卷 322-332页

作者： Yun Jin Yang-Yang Feng Xiao-Gang Qi Geng Hao Yuan-Quan Yu Jiang-Tao Li Shu-You Peng Department of General Surgery the Second Affiliated Hospital College of Medicine Zhejiang University

BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic *** To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager *** clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were *** The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 *** further analysis,11 trials were included from nine *** all,909 patients underwent PG and 856 underwent ***-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two ***,postoperative bleeding is significantly higher in PG than in *** PJ or binding PG is a safe and secure technique according to our decades of experience.

关键词： Pancreaticojejunostomy pancreaticogastrostomy Systematic review Metaanalysis

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Considerations on pancreatic exocrine function after pancreaticoduodenectomy

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 325-329页

作者： Francisco José Morera-Ocon Luis Sabater-Orti Elena Muoz-Forner Jaime Pérez-Griera Joaquín Ortega-Serrano Department of General Surgery Hospital Clinico de Valencia46010 ValenciaSpain Clinical Analysis Laboratory Hospital Clinico de Valencia

The pancreaticoduodenectomy(PD) procedure may lead to pancreatic exocrine and endocrine *** are several types of reconstruction for this kind of ***(PG) was introduced to reduce the rate of postoperative pancreatic *** some randomized control trials have shown no differences regarding pancreatic leakage between PG and pancreaticojejunostomy(PJ),recently some reports reveal benefits from the PG over the *** surgeons concern about the performing of the PG and inactivation of pancreatic enzymes being in contact with the gastric juice,and the detrimental results over the exocrine pancreatic *** pancreatic exocrine function can be measured with direct and indirect *** tests have the highest sensitivity and specificity for detection of exocrine insufficiency but require tube *** the tubeless indirect tests,the van de Kamer stool fat analysis remains the standard to diagnose fat *** patient compliance and time consuming makes it not so suitable for its clinical *** immunoreactive elastase test is employed for screening of exocrine insufficiency,is not cumbersome,and has been used to study pancreatic function after *** analyze the FE1 levels in our patients after the PD with two types of reconstruction,PG and PJ,and we discuss some considerations about the pancreaticointestinal drainage method after pancreaticoduodenectomy.

关键词： Pancreaticoduodenectomy pancreaticogastrostomy Pancreaticojejunostomy Pancreatic exocrine function Fecal elastase

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Endoscopic pancreatogastric anastomosis in the treatment of symptoms associated with inflammatory diseases of the pancreas

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 406-412页

作者： Mateusz Jagielski Eryk Bella Marek Jackowski Department of General Gastroenterological and Oncological SurgeryNicolaus Copernicus UniversityToruń87-100Poland

BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory *** basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive ***,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic *** is the treatment of choice in such *** To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)*** Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General,Gastroenterological and Oncological Surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,*** In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during *** of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after *** success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)***-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,espec

关键词： pancreaticogastrostomy Chronic pancreatitis Acute pancreatitis Disconnected pancreatic duct syndrome Endotherapy

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