Evaluation of Our Approach (Modified Blumgart Anastomosis) to Reducing the Incidence of Postoperative Pancreatic Fistula after a Pancreaticoduodenectomy in Cases with a Soft Pancreas
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Pancreatic fistula
Objective
To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.
Methods
Clinical data of 351 patients who underwent pancreaticoduodenectomy in our hospital from Jan 2001 to Dec 2015 were retrospectively analyzed.
Results
The overall incidence of pancreatic fistula was 20.2% (71/351), with grade A in 34 (9.7%) patients, grade B in 25 (7.1%), and grade C in 12 (3.4%). Postoperative hospital stay was significantly prolonged in patients with grade B and C pancreatic fistula. Multivariate analysis using Logistic regression identified three variables as independent factors associated with pancreatic fistula, namely, BMI (OR=2.281), preoperative total bilirubin level (OR=2.180) and soft pancreatic texture (OR=3.653). Preoperative total bilirubin level (OR=2.684), soft pancreatic texture (OR=5.128) and postoperative hemorrhage (OR=9.030) were independent risk factors of grade B and C pancreatic fistula after pancreaticoduodenectomy.
Conclusions
The incidence of pancreatic fistula after pancreaticoduodenectomy is still high. Pancreatic fistula prolongs the postoperative hospital stay significantly. The incidence of grade B and C pancreatic fistula could be reduced by avoiding postoperative hemorrhage.
Key words:
Pancreaticoduodenectomy; Pancreatic fistula; Risk factors
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Objective To discuss the experiences in the prevention and treatment of pancreatic fistula after pancreaticoduodenectomy. Methods We retrospectively analyzed 209 cases received pancreaticoduodenectomy from 1995 to 2010. We analyzed the causes of pancreatic fistula, prevention and treatment of pancreatic fistula. Results Incidence of pancreatic fistula had no significant difference betweenthe different age, gender, pancreatic texture, with or without preoperative jaundice, anemia, hypoproteinemia and different surgical approach of pancreatojejunostomy. Incidence of pancreatic fistula had significant difference between different surgical groups (surgical techniques). Conclusions Appropriate perioperative management, skilled surgical operation can significantly reduce the incidence of pancreatic fistula. Skilled surgical operation, particularly pancreatic and intestinal anastomosis individualized treatment is crucial to prevent pancreatic fistula after PD.
Key words:
Pancreaticoduodenectomy ; Pancreatic fistula ; Treatment ; Prevention ;
Pancreatic fistula
Hypoproteinemia
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Objective To summarize the experience and to lower operative morbidity through analyzing the cases of pancreatic fistula after pancreaticoduodenectomy from Jan. 1986 to Juen 2001. Methods Data of 62 cases of pancreaticoduodenectomy from Jan. 1986 to June 2001 were retrospectively analyzed. Results Of the 62 cases undergoing pancreaticoduodenectomy, pancreatic fistula occurred in 9 cases with a morbidity rate of 14. 5%. In 5 of the 8 cases (62. 5%). Pancreatic fistula occurred between Jan. 1986 and Dec. 1991, and in 6 of the remaining 54 cases (7. 4%) between Jan. 1992 and June 2001. Two patients (3. 2%) died in perioperation because of pancreatis fistula leading to systemic failure. The overall morbidity of pancrteatic fistula was 22.2%. Conclusions To lower the morbidity of pancreatic fistula, the key lies in improving the operative skill and mode in addtion to pre- and postoperative supporting therapy, use of somatostatin, control of infection and effective gastrointestinal decompression. Most pancreatic fistulas can be cured by early diagnosis and combined therapy.
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Objective To evaluate the various methods in prevention of pancreatic fistula after pancreaticoduodenectomy.Methods The literatures over the years related to prevention of pancreatic fistula were reviewed.Results Management of the pancreatic stump following pancreaticoduodenectomy played the most important role in preventing pancreatic fistula. None of the methods of pancreatic stump had proved to be perfect in preventing pancreatic fistula, though pancreaticojejunostomy was the most widely practiced reconstruct strategy in varieties of option. For pancreaticojejunostomy and pancreaticogastrostomy, the rate of this complication was 12.3% and 11.1%,respectively. In recent years, a new procedure, binding up pancreaticoduodenectomy, had shown a promise and excellent results in prevention of pancreatic fistula, the rate of fistula was 0 for consecutive 100 cases after pancreaticoduodenectomy.Conclusion Binding up pancreaticojejunostomy have a definite effect to avoid pancreatic fistula and be worthy of being recommended
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Objective To explore the prevention and treatment of pancreatic fistula secondary to pancreaticoduodenectomy.Methods We retrospectively analyzed the clinical data of 14 pancreatic fistula cases after pancreaticoduodenectomy from January 2008 and November 2010.Results There were 14 patients with pancreatic fistula after pancreaticoduodenectomy,and the incidence rate was 18.4 %.And 12 patients were cured by expectant treatment.The other 2 patients underwent re-operation.There was one patient dead,and the death rate was 7.1%.Conclusions The incidence and death rate of pancreatic fistula after pancreaticoduodenectomy are still high.The reduce the rate of pancreatic fistula lies in the reasonable treatment during or after operation.
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Although pancreaticoduodenectomy technique has been improved,but pancreatic fistula is still the most serious postoperative complication.Relative literatures were reviewed in this article according to the definition,the related factors and the treatment of pancreatic fistula.
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Objective To explore the methods of decreasing pancreatic fistula rates after pancreaticoduodenectomy. Methods This paper was made on the review of recent literatures about preventing pancreatic fistula after pancreaticoduodenectomy. Results Pancreatic fistula is still one of the main common complications of pancreaticoduodenectomy. Pancreatic stamp is managed mostly by pancreato enteric or pancreato gastric anastomosis. Ligation of the pancreatic duct and total pancreatectomy have reduced gradully. It is still undertermined that perioperative somatostatin can prevent pancreatic fistula. Conclusions The key point of deteasing pancreatic fistula rate of pancreaticoduodenectomy is to master all sorts of ways in managing the pancreatic stump.
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