Document Detail


Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results.
MedLine Citation:
PMID:  18367135     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The morbidity associated with pancreatic fistula formation after pancreaticoduodenectomy (PD) still remains high. While theoretically 2-stage pancreatojejunostomy (PJ) is effective for preventing pancreatic juice enzymes from becoming activated by enteric contents, its clinical usefulness remains unknown. The aim of this retrospective study was to evaluate the short-term results of two-stage PJ in PD. PATIENTS AND METHODS: In PD cases with a narrow main pancreatic duct and/or soft texture of the pancreas, we performed 2-stage PJ; first an external tube pancreatostomy was performed, in which the tube was not passed through the jejunal loop, followed about 3 months later by second-stage reconstruction for PJ. Between 1998 and 2005, PDs with 1-stage and 2-stage PJ were performed in 53 and 99 patients, respectively, at our institution. Among the latter 99 patients, 13 (13%) also underwent concomitant right or extended right hemi-hepatectomy. In this study, the clinical records of these 152 patients were retrospectively analyzed. RESULTS: After PD, a pancreatic fistula occurred in 58% of the patients undergoing 2-stage PJ; however, the fistula healed with conservative therapy in all but 2 patients who required surgical drainage for abdominal abscess. A second-stage pancreato-enteric reconstruction by PJ could be completed about 3 months after the PD in 89 of the 99 (90%) cases. Although the incidence of pancreatic fistula was 16% after the second-stage reconstruction for PJ, completion pancreatectomy was not needed in any of the cases. There were no deaths or other catastrophic events related to the procedure. CONCLUSIONS: While it is difficult to completely prevent pancreatic fistula formation after PD, a 2-stage PJ appears to be effective for minimizing pancreatic juice-related adverse events, especially in high-risk patients with a narrow pancreatic duct or undergoing highly invasive surgery, such as hepato-pancreticoduodenectomy.
Authors:
Kiyoshi Hasegawa; Norihiro Kokudo; Keiji Sano; Yasuji Seyama; Taku Aoki; Mami Ikeda; Takuya Hashimoto; Yoshifumi Beck; Hiroshi Imamura; Yasuhiko Sugawara; Masatoshi Makuuchi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of surgery     Volume:  196     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-20     Completed Date:  2008-07-15     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3-10     Citation Subset:  AIM; IM    
Affiliation:
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Feasibility Studies
Female
Humans
Male
Middle Aged
Pancreatic Fistula / etiology,  prevention & control*
Pancreaticoduodenectomy* / adverse effects
Pancreaticojejunostomy / methods*
Retrospective Studies
Comments/Corrections
Comment In:
Am J Surg. 2008 Jul;196(1):11-2   [PMID:  18367137 ]

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