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The challenge of pancreatic anastomosis

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Abstract

Background and aims

Significant progress in surgical technique and perioperative management has substantially reduced the mortality rate of pancreatic surgery. However, morbidity remains considerably high, even in expert hands and leakage from the pancreatic stump still accounts for the majority of surgical complications after pancreatic head resection. For that reason, management of the pancreatic remnant after partial pancreatoduodenectomy remains a challenge. This review will focus on technique, pitfalls, and complication management of pancreaticoenteric anastomoses.

Materials and methods

A medline search for surgical guidelines, prospective randomized controlled trials, systematic metaanalysis, and clinical reports was performed with regard to surgical technique and complication management of pancreatic anastomoses.

Results

Pancreaticojejunostomy appears to be most widely performed, but pancreaticogastrostomy is a reasonable alternative. Postoperative treatment with octreotide can be recommended only for patients with soft pancreatic tissue, and neither stents of the pancreatic duct nor drainages have proven to effectively reduce anastomotic complications. Gastroparesis remains the most common complication after pancreatic surgery and should be treated conservatively. However, it may be a symptom of other local complications, such as anastomotic leakage, pancreatic fistula or abscess. All septic complications may finally result in late postoperative hemorrhage, which requires immediate diagnostic workup and therapy. Today, interventional radiology has emerged as a standard tool in the management of local septic complications and bleeding. Therefore, relaparotomy has become less frequent and salvage pancreatectomy is now a rare procedure in case of local complications.

Conclusion

The surgeon’s experience with one or the other technique of pancreatic anastomosis appears to be more important than the technique itself.

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References

  1. Beger HG, Gansauge F, Schwab M, Poch B (2007) Pancreatic head resection: the risk for local and systemic complications in 1315 patients - a monoinstitutional experience. Am J Surg 194:S16–S19

    Article  Google Scholar 

  2. Berberat PO, Friess H, Kleeff J, Uhl W, Buchler MW (1999) Prevention and treatment of complications in pancreatic cancer surgery. Dig Surg 16:327–336

    Article  PubMed  CAS  Google Scholar 

  3. Bottger TC, Junginger T (1999) Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resections. World J Surg 23:164–171 discussion 171–2

    Article  PubMed  CAS  Google Scholar 

  4. Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889

    Article  PubMed  Google Scholar 

  5. Büchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’Graggen K (2003) Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 138:1310–1314 discussion 1315

    Article  PubMed  Google Scholar 

  6. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J (1993) One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 217:430–435 discussion 435–8

    Article  PubMed  CAS  Google Scholar 

  7. de Castro SM, Busch OR, Gouma DJ (2004) Management of bleeding and leakage after pancreatic surgery. Best Pract Res Clin Gastroenterol 18:847–864

    PubMed  Google Scholar 

  8. Neoptolemos JP, Russell RC, Bramhall S, Theis B (1997) Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg 84:1370–1376

    Article  PubMed  CAS  Google Scholar 

  9. Trede M, Saeger HD, Schwall G, Rumstadt B (1998) Resection of pancreatic cancer–surgical achievements. Langenbecks Arch Surg 383:121–128

    PubMed  CAS  Google Scholar 

  10. Trede M, Schwall G, Saeger HD (1990) Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 211:447–458

    Article  PubMed  CAS  Google Scholar 

  11. Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, Lillemoe KD, Pitt HA (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588 discussion 588–92

    PubMed  CAS  Google Scholar 

  12. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257 discussion 257–60

    Article  PubMed  CAS  Google Scholar 

  13. Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL (1997) Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 225:590–599 discussion 599–600

    Article  PubMed  CAS  Google Scholar 

  14. Miedema BW, Sarr MG, van Heerden JA, Nagorney DM, McIlrath DC, Ilstrup D (1992) Complications following pancreaticoduodenectomy. Current management. Arch Surg 127:945–949 discussion 949–50

    PubMed  CAS  Google Scholar 

  15. Geer RJ, Brennan MF (1993) Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 165:68–72 discussion 72–3

    Article  PubMed  CAS  Google Scholar 

  16. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232:786–795

    Article  PubMed  CAS  Google Scholar 

  17. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579

    Article  PubMed  CAS  Google Scholar 

  18. Bruns CJ, Jauch KW (2007) Surgical treatment of pancreatic cancer. Dtsch Med Wochenschr 132:798–802

    Article  PubMed  CAS  Google Scholar 

  19. Bakkevold KE, Kambestad B (1993) Morbidity and mortality after radical and palliative pancreatic cancer surgery. Risk factors influencing the short-term results. Ann Surg 217:356–368

    Article  PubMed  CAS  Google Scholar 

  20. Shrikhande SV, Qureshi SS, Rajneesh N, Shukla PJ (2005) Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World J Surg 29:1642–1649

    Article  PubMed  Google Scholar 

  21. Batignani G, Fratini G, Zuckermann M, Bianchini E, Tonelli F (2005) Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int 4:450–455

    PubMed  Google Scholar 

  22. Watanabe M, Usui S, Kajiwara H, Nakamura M, Sumiyama Y, Takada T, Nagakawa T (2004) Current pancreatogastrointestinal anastomotic methods: results of a Japanese survey of 3109 patients. J Hepatobiliary Pancreat Surg 11:25–33

    Article  PubMed  Google Scholar 

  23. Goldsmith HS, Gosh BC, Hivos AG (1971) Ligation versus implantation of the pancreatic duct after pancreaticoduodenectomy. Surg Gynecol Obstet 132:87–92

    PubMed  CAS  Google Scholar 

  24. Tran K, Van Eijck C, Di Carlo V, Hop WC, Zerbi A, Balzano G, Jeekel H (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236:422–428 discussion 428

    Article  PubMed  Google Scholar 

  25. McKay A, Mackenzie S, Sutherland FR, Bathe OF, Doig C, Dort J, Vollmer CM Jr, Dixon E (2006) Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br J Surg 93:929–936

    Article  PubMed  CAS  Google Scholar 

  26. Kingsnorth AN (1989) Duct to mucosa isolated Roux loop pancreaticojejunostomy as an improved anastomosis after resection of the pancreas. Surg Gynecol Obstet 169:451–453

    PubMed  CAS  Google Scholar 

  27. Sutton CD, Garcea G, White SA, O’Leary E, Marshall LJ, Berry DP, Dennison AR (2004) Isolated Roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks. J Gastrointest Surg 8:701–705

    Article  PubMed  Google Scholar 

  28. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, Salvia R, Pederzoli P (2003) Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 134:766–771

    Article  PubMed  Google Scholar 

  29. Marcus SG, Cohen H, Ranson JH (1995) Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 221:635–645 discussion 645–8

    Article  PubMed  CAS  Google Scholar 

  30. Tani M, Onishi H, Kinoshita H, Kawai M, Ueno M, Hama T, Uchiyama K, Yamaue H (2005) The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg 29:76–79

    Article  PubMed  Google Scholar 

  31. Biehl T, Traverso LW (1992) Is stenting necessary for a successful pancreatic anastomosis? Am J Surg 163:530–532

    Article  PubMed  CAS  Google Scholar 

  32. Dai XW, Ma K, Wang FX, Yang FQ, Wang BS, Zhao HY, Sun W, Liu BL, Qiu F, Pu XM, Wang L, Dai Y (2003) Prevention of pancreaticojejunal anastomotic leakage after pancreaticoduodenectomy with separate internal drainage of bile and pancreatic fluid. Hepatobiliary Pancreat Dis Int 2:131–134

    PubMed  Google Scholar 

  33. Langrehr JM, Bahra M, Jacob D, Glanemann M, Neuhaus P (2005) Prospective randomized comparison between a new mattress technique and Cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg 29:1111–1119 discussion 1120–1

    Article  PubMed  Google Scholar 

  34. Roder JD, Stein HJ, Bottcher KA, Busch R, Heidecke CD, Siewert JR (1999) Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg 229:41–48

    Article  PubMed  CAS  Google Scholar 

  35. Z’Graggen K, Uhl W, Friess H, Buchler MW (2002) How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg 9:733–737

    Article  PubMed  Google Scholar 

  36. Warren KW, Cattell RB (1956) Basic techniques in pancreatic surgery. Surg Clin North Am 36:707–724

    PubMed  CAS  Google Scholar 

  37. Peng SY, Mou YP, Liu YB, Su Y, Peng CH, Cai XJ, Wu YL, Zhou LH (2003) Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg 7:898–900

    Article  PubMed  Google Scholar 

  38. Rao AC, Gabriel G, Serrano J, Benedicto R (2004) Inkwell pancreaticojejunal anastomosis after pancreaticoduodenectomy. Am J Surg 187:410–412

    Article  PubMed  Google Scholar 

  39. Ohwada S, Iwazaki S, Nakamura S, Ogawa T, Tanahashi Y, Ikeya T, Iino Y Morishita Y (1997) Pancreaticojejunostomy-securing technique: duct-to-mucosa anastomosis by continuous running suture and parachuting using monofilament absorbable thread. J Am Coll Surg 185:190–194

    PubMed  CAS  Google Scholar 

  40. Delcore R, Thomas JH, Pierce GE, Hermreck AS (1990) Pancreatogastrostomy: a safe drainage procedure after pancreatoduodenectomy. Surgery 108:641–645 discussion 645–7

    PubMed  CAS  Google Scholar 

  41. Icard P, Dubois F (1988) Pancreaticogastrostomy following pancreatoduodenectomy. Ann Surg 207:253–256

    Article  PubMed  CAS  Google Scholar 

  42. Mason GR, Freeark RJ (1995) Current experience with pancreatogastrostomy. Am J Surg 169:217–219

    Article  PubMed  CAS  Google Scholar 

  43. Adloff M, Schloegel M, Ollier JC, Cuvelier G (1992) Pancreatojejunostomy or pancreatogastrostomy after cephalic pancreatoduodenectomy. Chirurgie 118:63–70

    PubMed  CAS  Google Scholar 

  44. Andivot T, Cardoso J, Dousset B, Soubrane O, Bonnichon P, Chapuis Y (1996) Complications of two types of pancreatic anastomosis after pancreaticoduodenectomy. Ann Chir 50:431–437

    PubMed  CAS  Google Scholar 

  45. Aranha GV, Hodul P, Golts E, Oh D, Pickleman J, Creech S (2003) A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 7:672–682

    Article  PubMed  Google Scholar 

  46. Arnaud JP, Tuech JJ, Cervi C, Bergamaschi R (1999) Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg 165:357–362

    Article  PubMed  CAS  Google Scholar 

  47. Kim SW, Youk EG, Park YH (1997) Comparison of pancreatogastrostomy and pancreatojejunostomy after pancreatoduodenectomy performed by one surgeon. World J Surg 21:640–643

    Article  PubMed  CAS  Google Scholar 

  48. Miyagawa S, Makuuchi M, Lygidakis NJ, Noguchi T, Nishimaki K, Hashikura Y, Harada H, Hayashi K, Kakazu T (1992) A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy–pancreaticojejunostomy vs. pancreaticogastrostomy. Hepatogastroenterology 39:381–384

    PubMed  CAS  Google Scholar 

  49. Oussoultzoglou E, Bachellier P, Bigourdan JM, Weber JC, Nakano H, Jaeck D (2004) Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 139:327–335

    Article  PubMed  Google Scholar 

  50. Schlitt HJ, Schmidt U, Simunec D, Jager M, Aselmann H, Neipp M, Piso P (2002) Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br J Surg 89:1245–1251

    Article  PubMed  CAS  Google Scholar 

  51. Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S (2000) Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 87:423–427

    Article  PubMed  CAS  Google Scholar 

  52. Wente MN, Shrikhande SV, Muller MW, Diener MK, Seiler CM, Friess H, Buchler MW (2007) Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 193:171–183

    Article  PubMed  Google Scholar 

  53. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767–771 discussion 771–3

    Article  PubMed  Google Scholar 

  54. Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM, Fingerhut A, Millat B, Radovanowic A, Fagniez PL (2005) A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 189:720–729

    Article  PubMed  Google Scholar 

  55. Connor S, Alexakis N, Garden OJ, Leandros E, Bramis J, Wigmore SJ (2005) Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg 92:1059–1067

    Article  PubMed  CAS  Google Scholar 

  56. Gyr KE, Meier R (1993) Pharmacodynamic effects of Sandostatin in the gastrointestinal tract. Digestion 54(Suppl 1):14–19

    PubMed  CAS  Google Scholar 

  57. Raptis S, Schlegel W, Lehmann E, Dollinger HC, Zoupas C (1978) Effects of somatostatin on the exocrine pancreas and the release of duodenal hormones. Metabolism 27:1321–1328

    Article  PubMed  CAS  Google Scholar 

  58. Büchler M, Friess H, Klempa I, Hermanek P, Sulkowski U, Becker H, Schafmayer A, Baca I, Lorenz D, Meister R et al (1992) Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 163:125–130

    Article  PubMed  Google Scholar 

  59. Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, Ribotta G, Fegiz G, Fissi S, Roviaro G, Peracchia A et al (1995) Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 117:26–31

    Article  PubMed  CAS  Google Scholar 

  60. Pederzoli P, Bassi C, Falconi M, Camboni MG (1994) Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group. Br J Surg 81:265–269

    Article  PubMed  CAS  Google Scholar 

  61. Sarr MG (2003) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 196:556–564 discussion 564–5; author reply 565

    Article  PubMed  Google Scholar 

  62. Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, Campbell KA, Choti MA (2000) Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 232:419–429

    Article  PubMed  CAS  Google Scholar 

  63. Braasch JW, Deziel DJ, Rossi RL, Watkins E Jr, Winter PF (1986) Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg 204:411–418

    Article  PubMed  CAS  Google Scholar 

  64. Patel AG, Toyama MT, Kusske AM, Alexander P, Ashley SW, Reber HA (1995) Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better? Arch Surg 130:838–842 discussion 842–3

    PubMed  CAS  Google Scholar 

  65. Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229:613–622 discussion 622–4

    Article  PubMed  CAS  Google Scholar 

  66. Zerbi A, Balzano G, Patuzzo R, Calori G, Braga M, Di Carlo V (1995) Comparison between pylorus-preserving and Whipple pancreatoduodenectomy. Br J Surg 82:975–979

    Article  PubMed  CAS  Google Scholar 

  67. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  68. Hartel M, Wente MN, Hinz U, Kleeff J, Wagner M, Muller MW, Friess H, Buchler MW (2005) Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 140:1094–1099

    Article  PubMed  Google Scholar 

  69. Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, Yamaue H (2006) Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 243:316–320

    Article  PubMed  Google Scholar 

  70. Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K, Michelassi F (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228:508–517

    Article  PubMed  CAS  Google Scholar 

  71. van Berge Henegouwen MI, van Gulik TM, DeWit LT, Allema JH, Rauws EA, Obertop H, Gouma DJ (1997) Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 185:373–379

    PubMed  Google Scholar 

  72. Yeo CJ, Barry MK, Sauter PK, Sostre S, Lillemoe KD, Pitt HA, Cameron JL (1993) Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 218:229–237 discussion 237–8

    Article  PubMed  CAS  Google Scholar 

  73. Tsao JI, Rossi RL, Lowell JA (1994) Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation. Arch Surg 129:405–412

    PubMed  CAS  Google Scholar 

  74. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  75. Connor S, Alexakis N, Garden OJ, Leandros E, Bramis J, Wigmore SJ (2005) Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg 92:1059–1067

    Article  PubMed  CAS  Google Scholar 

  76. Bartoli FG, Arnone GB, Ravera G, Bachi V (1991) Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res 11:1831–1848

    PubMed  CAS  Google Scholar 

  77. Friess H, Malfertheiner P, Isenmann R, Kuhne H, Beger HG, Buchler MW (1996) The risk of pancreaticointestinal anastomosis can be predicted preoperatively. Pancreas 13:202–208

    PubMed  CAS  Google Scholar 

  78. Hamanaka Y, Nishihara K, Hamasaki T, Kawabata A, Yamamoto S, Tsurumi M, Ueno T, Suzuki T (1996) Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage. Surgery 119:281–287

    Article  PubMed  CAS  Google Scholar 

  79. Farley DR, Schwall G, Trede M (1996) Completion pancreatectomy for surgical complications after pancreaticoduodenectomy. Br J Surg 83:176–179

    Article  PubMed  CAS  Google Scholar 

  80. van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ (1997) Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 185:18–24

    PubMed  Google Scholar 

  81. Yeo CJ (1995) Management of complications following pancreaticoduodenectomy. Surg Clin North Am 75:913–924

    PubMed  CAS  Google Scholar 

  82. Gervais DA, Fernandez-del Castillo C, O’Neill MJ, Hahn PF, Mueller PR (2001) Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics 21:673–690

    PubMed  CAS  Google Scholar 

  83. vanSonnenberg E, Wittich GR, Chon KS, D’Agostino HB, Casola G, Easter D, Morgan RG, Walser EM, Nealon WH, Goodacre B, Stabile BE (1997) Percutaneous radiologic drainage of pancreatic abscesses. AJR Am J Roentgenol 168:979–984

    PubMed  CAS  Google Scholar 

  84. vanSonnenberg E, Wittich GR, Goodacre BW, Casola G, D’Agostino HB (2001) Percutaneous abscess drainage: update. World J Surg 25:362–369 discussion 370–2

    Article  PubMed  CAS  Google Scholar 

  85. Cullen JJ, Sarr MG, Ilstrup DM (1994) Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg 168:295–298

    Article  PubMed  CAS  Google Scholar 

  86. Smith CD, Sarr MG, vanHeerden JA (1992) Completion pancreatectomy following pancreaticoduodenectomy: clinical experience. World J Surg 16:521–524

    Article  PubMed  CAS  Google Scholar 

  87. Beger HG, Rau B, Gansauge F, Poch B. The risk of pancreatic head resection - a monoinstitutional experience. in American Pancreatic Club Meeting. 2006. Los Angeles, CA.

  88. Wu CC, Hwang CR, Yeh DC, Hwang YC, Liu TJ, P’Eng FK (1996) Treatment for dehiscence of pancreaticojejunostomy after pancreaticoduodenectomy: is resection of the residual pancreas necessary? Hepatogastroenterology 43:271–274

    PubMed  CAS  Google Scholar 

  89. Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T (1999) Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg 6:303–311

    Article  PubMed  CAS  Google Scholar 

  90. Koukoutsis I, Bellagamba R, Morris-Stiff G, Wickremesekera S, Coldham C, Wigmore SJ, Mayer AD, Mirza DF, Buckels JA, Bramhall SR (2006) Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed. Dig Surg 23:224–228

    Article  PubMed  CAS  Google Scholar 

  91. Meinke WB, Twomey PL, Guernsey JM, Frey CF, Farias LR, Higgins G, Keehn R (1983) Gastrointestinal bleeding after operation for pancreatic cancer. Am J Surg 146:57–60

    Article  PubMed  CAS  Google Scholar 

  92. Rumstadt B, Schwab M, Korth P, Samman M, Trede M (1998) Hemorrhage after pancreatoduodenectomy. Ann Surg 227:236–241

    Article  PubMed  CAS  Google Scholar 

  93. Shankar S, Russell RC (1989) Haemorrhage in pancreatic disease. Br J Surg 76:863–866

    Article  PubMed  CAS  Google Scholar 

  94. van Berge Henegouwen MI, Allema JH, van Gulik TM, Verbeek PC, Obertop H, Gouma DJ (1995) Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg 82:1527–1531

    Article  PubMed  Google Scholar 

  95. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  96. Balladur P, Christophe M, Tiret E, Parc R (1996) Bleeding of the pancreatic stump following pancreatoduodenectomy for cancer. Hepatogastroenterology 43:268–270

    PubMed  CAS  Google Scholar 

  97. Wente MN, Shrikhande SV, Kleeff J, Muller MW, Gutt CN, Buchler MW, Friess H (2006) Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy. Dig Surg 23:203–208

    Article  PubMed  Google Scholar 

  98. de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Lameris JS, van Gulik TM, Obertop H, Gouma DJ (2005) Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 241:85–91

    PubMed  Google Scholar 

  99. Makowiec F, Riediger H, Euringer W, Uhl M, Hopt UT, Adam U (2005) Management of delayed visceral arterial bleeding after pancreatic head resection. J Gastrointest Surg 9:1293–1299

    Article  PubMed  Google Scholar 

  100. Yamashita Y, Taketomi A, Fukuzawa K, Tsujita E, Harimoto N, Kitagawa D, Kuroda Y, Kayashima H, Wakasugi K, Maehara Y (2007) Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg 193:454–459

    Article  PubMed  Google Scholar 

  101. Brodsky JT, Turnbull AD (1991) Arterial hemorrhage after pancreatoduodenectomy. The ‘sentinel bleed’. Arch Surg 126:1037–1040

    PubMed  CAS  Google Scholar 

  102. Choi SH, Moon HJ, Heo JS, Joh JW, Kim YI (2004) Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 199:186–191

    Article  PubMed  Google Scholar 

  103. Sato N, Yamaguchi K, Shimizu S, Morisaki T, Yokohata K, Chijiiwa K, Tanaka M (1998) Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg 133:1099–1102

    Article  PubMed  CAS  Google Scholar 

  104. Turrini O, Moutardier V, Guiramand J, Lelong B, Bories E, Sannini A, Magnin V, Viret F, Blache JL, Giovannini M, Delpero JR (2005) Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding. World J Surg 29:212–216

    Article  PubMed  Google Scholar 

  105. Otah E, Cushin BJ, Rozenblit GN, Neff R, Otah KE, Cooperman AM (2002) Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg 137:55–59

    Article  PubMed  Google Scholar 

  106. Kurosaki I, Hatakeyama K (2004) Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy. Int Surg 89:90–94

    PubMed  Google Scholar 

  107. de Perrot M, Berney T, Buhler L, Delgadillo X, Mentha G, Morel P (1999) Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 86:29–32

    Article  PubMed  Google Scholar 

  108. Stosslein F, Zimmermann L, Bulang T (1998) Embolization treatment of bleeding complications in pancreatitis. J Hepatobiliary Pancreat Surg 5:344–347

    Article  PubMed  CAS  Google Scholar 

  109. Gebauer T, Schulz HU, Tautenhahn J, Halloul Z, Effenberger O, Lippert H, Burger T (2004) [Interventional and vascular surgical management for inflammatory arrosion hemorrhage from visceral arteries following pancreatic surgery]. Chirurg 75:1021–1028

    Article  PubMed  CAS  Google Scholar 

  110. Tien YW, Lee PH, Yang CY, Ho MC, Chiu YF (2005) Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 201:554–559

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Markus Rentsch, M.D., for preparing the illustrations (Fig. 1).

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  1. Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Axel Kleespies, Markus Albertsmeier, Firas Obeidat, Hendrik Seeliger, Karl-Walter Jauch & Christiane J. Bruns

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  1. Axel Kleespies
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  2. Markus Albertsmeier
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Correspondence to Axel Kleespies.

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Kleespies, A., Albertsmeier, M., Obeidat, F. et al. The challenge of pancreatic anastomosis. Langenbecks Arch Surg 393, 459–471 (2008). https://doi.org/10.1007/s00423-008-0324-4

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