Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection
Restricted accessResearch articleFirst published online January, 2018
Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection
The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with (n = 10) and without (n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer (P < 0.01) and blood loss significantly greater (P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent (P = 0.02) and postoperative hospital stay was significantly longer (P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.
ZhangT., XuJ., WangT.Enucleation of pancreatic lesions: indications, outcomes, and risk factors for clinical pancreatic fistula.J Gastrointest Surg2013; 17: 2099–104.
3.
FalconiM., ZerbiA., CrippaS.Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors.Ann Surg Oncol2010; 17: 1621–7.
4.
HackertT., HinzU., FritzS.Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections.Langenbecks Arch Surg2011; 396: 1197–203.
5.
DedieuA., RaultA., ColletD.Laparoscopic enucleation of pancreatic neoplasm.Surg Endosc2011; 25: 572–6.
6.
SongK.B., KimS.C., HwangD.W.Enucleation for benign or low-grade malignant lesions of the pancreas: Single-center experience with 65 consecutive patients.Surgery2015; 158: 1203–10.
7.
BrientC., RegenetN., SulpiceL.Risk factors for postoperative pancreatic fistulization subsequent to enucleation.J Gastrointest Surg2012; 16: 1883–7.
8.
HeegerK., FalconiM., PartelliS.Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors.Langenbecks Arch Surg2014; 399: 315–21.
9.
FaitotF., GaujouxS., BarbierL.Reappraisal of pancreatic enucleations: a single-center experience of 126 procedures.Surgery2015; 158: 201–10.
10.
OhtsukaT., TakahataS., TakanamiH.Laparoscopic surgery is applicable in larger mucinous cystic neoplasms of the pancreas.J Hepatobiliary Pancreat Sci2014; 21: 343–8.
11.
ClavienP.A., BarkunJ., de OliveiraM.L.The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg2009; 250: 187–96.
12.
BassiC., MarchegianiG., DervenisC.https://www.ncbi.nlm.nih.gov/pubmed/28040257The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.Surgery2017; 161: 584–91.
13.
WenteM.N., BassiC., DervenisC.Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).Surgery2007; 142: 761–8.
14.
WenteM.N., VeitJ.A., BassiC.Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.Surgery2007; 142: 20–5.
15.
SethT.N.The activation of pancreatic juice by enterokinase.Biochem J1924; 18: 1401–16.
16.
PengS.Y., WangJ.W., LauW.Y.Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial.Ann Surg2007; 245: 692–8.
17.
MaggioriL., SauvanetA., NagarajanG.Binding versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: a case-matched study.J Gastrointest Surg2010; 14: 1395–400.
