Relative Displacement of Anastomotic Site of Pancreato-jejunostomy in Pancreatico-duodenectomy: a Novel Surgical Reconstructive Technique

Overview

Journal J Med Case Rep

Publisher Biomed Central

Specialty General Medicine

Date 2013 Aug 16

PMID 23945081

Authors

Teruyuki Usuba

Toshio Iino

Nobuyoshi Hanyu

Affiliations

Soon will be listed here.

Abstract

Introduction: Intra-abdominal hemorrhage following pancreatic fistula is a fatal complication after pancreatico-duodenectomy. Intra-abdominal hemorrhage has reportedly decreased with the use of fibrin glue or polyglycolic acid felt and wrapping of the skeletonized vessels by omentum or falciform ligament. However, there are no extremely effective methods for the prevention of hemorrhage. Here, we report our novel and simple method for the prevention of intra-abdominal hemorrhage due to pancreatic fistula.

Methods: The anastomotic site of the pancreato-jejunostomy in pancreatico-duodenectomy is displaced from the superior to inferior side of the transverse mesocolon through a small window created on the left side of the middle colic artery of the transverse mesocolon. This procedure is expected to prevent exposure of the skeletonized vessels to activated pancreatic juice from a pancreatic fistula after lymph node dissection, decreasing the incidence of hemorrhage. Two drains are placed on the superior and inferior sides of the transverse mesocolon. We performed this procedure in seven patients and compared the amylase level in the drainage fluid from the superior and inferior sides.

Results: There was no difference in the fluid amylase level from the drains between the superior and inferior sides, because a pancreatic fistula was not present in all our patients. Therefore, we could not evaluate the efficacy of this method in the current study.

Conclusions: Our procedure is theoretically expected to prevent intra-abdominal hemorrhage and will be an option in pancreatico-duodenectomy, especially for patients with a soft pancreas. However, it is necessary to evaluate the performance and results of this procedure in many more patients.

References

Lillemoe K, Cameron J, Kim M, Campbell K, Sauter P, Coleman J . Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg. 2004; 8(7):766-72. DOI: 10.1016/j.gassur.2004.06.011. View

Tani M, Kawai M, Yamaue H . Intraabdominal hemorrhage after a pancreatectomy. J Hepatobiliary Pancreat Surg. 2008; 15(3):257-61. DOI: 10.1007/s00534-007-1303-9. View

Zerbi A, Balzano G, Patuzzo R, Calori G, Braga M, Di Carlo V . Comparison between pylorus-preserving and Whipple pancreatoduodenectomy. Br J Surg. 1995; 82(7):975-9. DOI: 10.1002/bjs.1800820738. View

Yang Y, Tian X, Zhuang Y, Wang W, Wan Y, Huang Y . Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol. 2005; 11(16):2456-61. PMC: 4305634. DOI: 10.3748/wjg.v11.i16.2456. View

Butturini G, Daskalaki D, Molinari E, Scopelliti F, Casarotto A, Bassi C . Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg. 2008; 15(3):247-51. DOI: 10.1007/s00534-007-1301-y. View

Yoshida T, Matsumoto T, Morii Y, Aramaki M, Bandoh T, Kawano K . Delayed massive intraperitoneal hemorrhage after pancreatoduodenectomy. Int Surg. 1998; 83(2):131-5. View

Cameron J, Riall T, Coleman J, Belcher K . One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006; 244(1):10-5. PMC: 1570590. DOI: 10.1097/01.sla.0000217673.04165.ea. View

Suc B, Msika S, Fingerhut A, Fourtanier G, Hay J, Holmieres F . Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Ann Surg. 2002; 237(1):57-65. PMC: 1513966. DOI: 10.1097/00000658-200301000-00009. View

Sakamoto Y, Shimada K, Esaki M, Kajiwara T, Sano T, Kosuge T . Wrapping the stump of the gastroduodenal artery using the falciform ligament during pancreaticoduodenectomy. J Am Coll Surg. 2007; 204(2):334-6. DOI: 10.1016/j.jamcollsurg.2006.11.015. View

10.

Allema J, Reinders M, van Gulik T, van Leeuwen D, Verbeek P, de Wit L . Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery. 1995; 117(3):247-53. DOI: 10.1016/s0039-6060(05)80197-7. View

11.

Uemura K, Murakami Y, Hayashidani Y, Sudo T, Hashimoto Y, Ohge H . Combination of polyglicolic acid felt and fibrin glue for prevention of pancreatic fistula following pancreaticoduodenectomy. Hepatogastroenterology. 2009; 56(94-95):1538-41. View

12.

Behrman S, Rush B, Dilawari R . A modern analysis of morbidity after pancreatic resection. Am Surg. 2004; 70(8):675-82. View

13.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

14.

Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce A, Di Carlo V . Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg. 2008; 95(11):1387-93. DOI: 10.1002/bjs.6324. View

15.

Rumstadt B, Schwab M, Korth P, Samman M, TREDE M . Hemorrhage after pancreatoduodenectomy. Ann Surg. 1998; 227(2):236-41. PMC: 1191241. DOI: 10.1097/00000658-199802000-00013. View

16.

Kurosaki I, Hatakeyama K . Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy. Int Surg. 2004; 89(2):90-4. View

17.

Maeda A, Ebata T, Kanemoto H, Matsunaga K, Bando E, Yamaguchi S . Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. World J Surg. 2005; 29(9):1122-6. DOI: 10.1007/s00268-005-7900-3. View

18.

Abe N, Sugiyama M, Suzuki Y, Yanagida O, Masaki T, Mori T . Falciform ligament in pancreatoduodenectomy for protection of skeletonized and divided vessels. J Hepatobiliary Pancreat Surg. 2009; 16(2):184-8. DOI: 10.1007/s00534-008-0036-8. View

19.

Baker T, Aaron J, Borge M, Pierce K, Shoup M, Aranha G . Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg. 2008; 195(3):386-90. DOI: 10.1016/j.amjsurg.2007.12.026. View