Innovations in pancreatic anastomosis technique during pancreatoduodenectomies
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Innovations in pancreatic anastomosis technique during pancreatoduodenectomies S. Ferencz 1 & Zs. Bíró 2 & A. Vereczkei 1 & D. Kelemen 1 Received: 16 June 2020 / Accepted: 21 July 2020 # The Author(s) 2020
Abstract Purpose Pancreatic fistula following pancreatic resections is still a relevant complication. The present work shows the efforts of a single institute to decrease this problem. Methods A total of 130 patients (63 men, 67 women) with a mean age of 60 (range: 23–81) years were operated on between January 2013 and March 2020. The most frequent type of pancreatic resection was a Whipple procedure with partial antrectomy. During all operations, an innovative method was used, namely a modification of the purse-string suture pancreatojejunostomy. Moreover, an early drain removal policy was applied, based on the drain amylase level on the first and subsequent postoperative days. Results Mean postoperative hospital stay was 13 days (range: 7–75). The overall morbidity rate was 43.8%; the clinically relevant (grade B/C) pancreatic fistula (CR-POPF) rate was 6.9%. Delayed gastric emptying (DGE) was observed in 4% of the patients. The ratio of operative mortality was 0.7%; the reoperation rate was 5.3%. Based on the drain amylase level on the first postoperative day, two groups could be established. In the first one, the drain was removed early, on the fourth day in average (range: 2–6). In the other group, the drain was left in situ protractedly or reinserted later on. Conclusion A single center’s experience proves that the refinement of the technique can improve the results of pancreatic surgery. Keywords Pancreatic resection . Purse-string suture pancreatojejunostomy Pancreatic fistula . Drain amylase level
Introduction
Material and methods
Surgical morbidity rate after pancreatic resections is still high (up to 50%) even in specialized centers. Beside delayed gastric emptying, biliary fistula, postoperative hemorrhage, surgical site infection, and other morbidities, pancreatic fistula is the most relevant complication with a rate of 10–15% after pancreatoduodenectomies [1]. Many efforts have been done to decrease this number, like several modifications of the pancreato-enteric anastomosis, stenting of the pancreatic duct, administration of somatostatin, etc.; however, no single method has been proven to be superior, according to the reviews and meta-analyses [2]. That is why pancreatic surgeons have continuously tried to find the ideal method for decades. The present paper shows such efforts of a single institute.
Between January 2013 and March 2020, 130 Whipple procedures (74 with partial antrectomy and 56 with preservation of the pylorus) were performed at the Department of Surgery, Clinical Center, Medical School, University of Pécs, Pécs, Hungary. Table 1 summarizes the patients’ data. The gender distribution was almost equal and the mean age was 60 years. The most common disease was a pancreatic neoplasia. During the procedure—after the radical resectional phase—a very simple type
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