The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury
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ORIGINAL ARTICLE
The bridge stenting‑based internal drainage in pancreatic trauma patients with main pancreatic duct injury Xu‑dong Wen1,2 · Dan‑qing Liu3 · Bing‑yin Zhang3 · Le Xiao3 · Hong‑tao Yan3 · Wei‑hui Liu1 Received: 31 December 2019 / Accepted: 18 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract Pancreatic trauma is associated with high mortality and morbidity, especially in main pancreatic duct (MPD) injuries. Here, we introduce a novel technique via the placement of bridge stenting-based internal drainage (BSID) along the injured MPD to restore pancreatic tissue integrity. Twelve patients with MPD injury underwent unobstructed BSID as physical support for healing. Six patients with peripheral organ injuries underwent operative end-to-end anastomosis of the MPD by using a polyurethane central venous catheter for the BSID, and the other six patients with isolated proximal MPD rupture received BSID via endoscopic pancreatic stent placement. The BSID technique was successfully performed in all pancreatic trauma patients without the need for a second open surgery. With this simplified BSID-based operation, a short procedure duration (242.7 ± 38.71 min in the surgical group and 100.2 ± 16.24 min in the endoscopic group) and a short hospital stay (13.0 ± 7.05 days) were achieved. However, a few complications (41.67%) still occurred, including pancreatitis, fistula, abscess, pseudocyst, cholangitis, and haemorrhage. Except for the deceased case, all postoperative courses were marked by decreases in the peripancreatic fluid collection, blood amylase recovery, and normal endocrine function. The BSID approach is a feasible surgical approach for the treatment of MPD injury and can be used endoscopically in isolated MPD injuries for its safety and convenience. Keywords Pancreatic trauma · Main pancreatic duct injury · Bridge stenting-based internal drainage · Endoscopic surgery · Pancreatic surgery
Introduction
Xu-dong Wen and Dan-qing Liu contributed equally to this work. * Hong‑tao Yan [email protected] * Wei‑hui Liu [email protected] 1
Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
2
Department of Gastroenterology and Hepatology, Chengdu First People’s Hospital, Chengdu 610016, Sichuan Province, China
3
General Surgery Center, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Pancreatic trauma is a relatively uncommon injury, which occurs in approximately 5–10% of blunt abdominal trauma cases [1]. Due to its proximity to important viscera (liver, spleen, duodenum, etc.) and major vascular structures, pancreatic injury is usually accompanied by other injuries as a combined injury, which is associated with high morbidity (up to 60%) and mortality (up to 30%) [2]. Pancreatic trauma can range in severity from parenchymal contusions and lacerations to ductal transection and mass destruction [3]. According to the Organ Injury Scale develo
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