Laparoscopic pancreatic surgery: Current indications and surgical results
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Pancreatic fistula
Splenic vein
Distal pancreatectomy
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Although, a variety of techniques have been described to reduce the risk of postoperative pancreatic fistula, there is no consensus on appropriate technique for closure of the pancreatic remnant after distal pancreatectomy. We developed a new surgical technique, transduodenal pancreatic juice drainage, for preventing postoperative pancreatic fistula. The procedure involves a transduodenal approach. A pancreatic stent was inserted into the main pancreatic duct from the papilla of Vater to its the distal side, and continuous suction drainage was performed. The pancreatic parenchyma was divided using a knife, and the main pancreatic duct was ligated. The cut surface of the remaining pancreas was closed by hand suturing. This procedure was performed on 10 patients, and none of them developed clinical postoperative pancreatic fistula. We consider our transduodenal pancreatic juice drainage technique to be an effective procedure for preventing postoperative pancreatic fistula in patients who have undergone distal pancreatectomy.
Pancreatic fistula
Major duodenal papilla
Pancreatic juice
Distal pancreatectomy
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Pancreatic fistula
Distal pancreatectomy
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Pancreatic fistula
Distal pancreatectomy
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Distal pancreatectomy represents the standard surgical procedure for the body and tail pancreatic tumors. This operation is associated with a high number of postoperative complications, especially pancreatic fistula. The purpose of this paper is to analyse the risk factors that predispose to the pancreatic fistula after distal pancreatectomy and to present the proposed methods of prevention for this complication.
Pancreatic fistula
Distal pancreatectomy
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Pancreatic fistula
Nomogram
Distal pancreatectomy
Concordance
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Distal pancreatectomy
Pancreatic fistula
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Although duct-to-mucosa pancreatojejunostomy has been considered safer than other techniques, this procedure is particularly difficult when the pancreatic duct is small. It has therefore become increasingly necessary to develop a simple mucosal sutureless pancreatojejunostomy technique to replace the conventional hand-sewing one. Two hundred fourteen patients who underwent mucosal sutureless pancreatojejunostomy were classified into two groups: those with a normal pancreatic duct diameter (less than 3 mm, n = 97) and those with a dilated pancreatic duct (3 mm or greater, n = 117). The rate of clinically significant pancreatic fistula (Grade B or C by the International Study Group on Pancreatic Fistula definition) among the patients as a whole was 8 per cent. The overall incidence of pancreatic fistula was significantly higher in the patients with a pancreatic duct diameter of less than 3 mm than in those with a pancreatic duct diameter of 3 mm or greater. However, the incidence of clinically significant pancreatic fistula did not differ between the groups (less than 3 mm, 11%; 3 mm or greater, 5%; P = 0.09). Grade C pancreatic fistula developed in one patient with a pancreatic duct diameter of less than 3 mm and in two with a pancreatic duct diameter 3 mm or greater. Although two patients required reoperation, all of the fistulas were cured and the postoperative mortality rate related to pancreatoduodenectomy was zero. Mucosal sutureless pancreatojejunostomy combined with pancreatic duct stenting is associated with a low rate of clinically significant pancreatic fistula even in patients with a small pancreatic duct diameter less than 3 mm.
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Pancreatic fistula
Distal pancreatectomy
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Background/Aim: The efficacy and safety of early drain removal following distal pancreatectomy in elderly patients are unclear. We aimed to investigate the short-term surgical outcomes following early drain removal after distal pancreatectomy in elderly patients. Patients and Methods: Fifty-seven patients aged ≥70 years who underwent distal pancreatectomy at our Hospital were enrolled in the study. Data were retrospectively analyzed to evaluate the short-term surgical outcomes following early drain removal after distal pancreatectomy in elderly patients. Results: The incidence of pancreatic fistula following distal pancreatectomy in the early-removal group was significantly lower vs. the conventional group (p=0.022). Multivariate analysis revealed that early drain removal was an independent factor for reducing the risk of pancreatic fistula after distal pancreatectomy in elderly patients (p=0.042). Conclusion: Early drain removal following distal pancreatectomy is an effective and safe surgical perioperative management procedure to prevent pancreatic fistula in elderly patients.
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