Abstract
Severe post-operative complications after pancreaticoduodenectomy (PD) are largely due to pancreatic fistula onset. The occlusion of the main pancreatic duct using synthetic glue may prevent these complications. Aim of this study is to describe this technique and to report short- and long-term results as well as the post-operative endocrine and exocrine insufficiency. Two hundred and four patients who underwent PD with occlusion of the main pancreatic duct in a period of 15 years were retrospectively analyzed. Post-operative complications and their management were the main aim of the study with particular focus on pancreatic fistula incidence and its treatment. At 1-year follow-up endocrine and exocrine functions were analyzed. We observed a 54 % pancreatic fistula incidence, most of which (77/204 patients) were a grade A fistula with little change in medical management. Twenty-eight patients developed a grade B fistula while only 2 % of patients (5/204) developed a grade C fistula. Nine patients required re-operation, 5 of whom had a post-operative grade C fistula. Post-operative mortality was 3.4 %. At 1-year follow-up, 31 % of patients developed a post-operative diabetes while exocrine insufficiency was encountered in 88 % of patients. The occlusion of the main pancreatic duct after PD can be considered a relatively safe and easy-to-perform procedure. It should be reserved to selected patients, especially in case of soft pancreatic texture and small pancreatic duct and in elderly patients with comorbidities, in whom pancreatic fistula-related complications could be life threatening.
Similar content being viewed by others
References
Cameron JL, Pitt HA, Yeo CJ et al (1993) One-hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 217:430–438
Lieberman MD, Kilburn H, Lindsey M et al (1995) Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 222:638–645
Trede M, Schwall G, Saeger H-D (1990) Survival after pancreaticoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg 211:447–458
Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588
Ridolfini MP, Alfieri S, Gourgiotis S, Di Miceli D, Rotondi F, Quero G, Manghi R, Doglietto GB (2007) Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial? World J Gastroenterol 13(38):5096–5100
Di Giorgio A, Alfieri S, Rotondi F, Prete F, Di Miceli D, Ridolfini MP, Rosa F, Covino M, Doglietto GB (2005) Pancreatoduodenectomy for tumors of Vater’s ampulla: report on 94 consecutive patients. World J Surg 29(4):513–518
Hashimoto Y, Traverso LW (2010) Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients: use of a web-based calculator to improve homogeneity of definition. Surgery 147(4):503–515. doi:10.1016/j.surg.2009.10.034
Harada N, Ishizawa T, Inoue Y, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, Tanaka M, Fukayama M, Kokudo N (2014) Acoustic radiation force impulse imaging of the pancreas for estimation of pathologic fibrosis and risk of postoperative pancreatic fistula. J Am Coll Surg 219(5):887–894. doi:10.1016/j.jamcollsurg.2014.07.940
Schoretsanitis GN, Tsiftsis DD, Tatoulis PA et al (1993) Pancreaticoduodenectomy with external drainage of the residual pancreatic duct. Eur J Surg 159:421–424
Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588
Aranha GV, Hodul P, Golts E et al (2003) A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 7:672–682
Arnaud JP, Tuech JJ, Cervi C et al (1999) Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg 165:357–362
Roder JD, Stein HJ, Bottcher KA et al (1999) Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: A prospective study. Ann Surg 229:41–48
Ohwada S, Tanahashi Y, Ogawa T et al (2002) In situ vs ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with Billroth I-type reconstruction. Arch Surg 137:1289–1293
Greene BS, Loubeau JM, Peoples JB et al (1991) Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg 161:45–50
Poon RT, Lo SH, Fong D et al (2002) Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg 183:42–52
Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM, Fingerhut A, Millat B, Radovanowic A, Fagniez PL, French Associations for Research in Surgery (2005) A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 189(6):720–729
Di Carlo V, Chiesa R, Pontiroli AE et al (1989) Pancreatoduodenectomy with occlusion of the residual stump by Neoprene injection. World J Surg 13:105–111
Tran K, Van Eijck C, Di Carlo V et al (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236:422–428
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25
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(1):18–24
Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136(4):391–398
Grobmyer SR, Rivadeneira DE, Goodman CA, Mackrell P, Lieberman MD, Daly JM (2000) Pancreatic anastomotic failure after pancreaticoduodenectomy. Am J Surg 180(2):117–120
Shrikehande SV, Qureshi SS, Rajneesh N et al (2005) Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies. World J Surg 29:1642–1649
Al-Sharaf C, Ishes I, Dawiskiba S et al (1997) Characteristics of the gland remnant predict complications after subtotal pancreaticoduodenectomy. Dig Surg 14:101–106
Sato N, Yamaguchi K, Chijiiwa K et al (1998) Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 133:1094–1098
Marcus SG, Cohen H, Ranson JHC (1995) Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 221:635–648
Sampaio JA, Pereira-Lima JC, Rhoden EL, Waechter FL, Smith M, Cardoso F, Pinto RD, Pereira-Lima L (1998) Pancreatic fistula after pancreaticoduodenectomy: a comparison between patients with periampullary tumors and chronic pancreatitis. Hepatogastroenterology 45(23):1855–1858
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(3):281–287
Stapleton GN, Williamson RC (1996) Proximal pancreatoduodenectomy for chronic pancreatitis. Br J Surg 83(10):1433–1440
Lillemoe KD, Cameron JL, Kim MP, Campbell KA, Sauter PK, Coleman JA, Yeo CJ (2004) Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 8(7):766–772
Ihse I, Anderson H, Andrén-Sandberg (1996) Total pancreatectomy for cancer of the pancreas: is it appropriate? World J Surg 20(3):288–293
Figueras J, Sabater L, Planellas P, Muñoz-Forner E, Lopez-Ben S, Falgueras L, Sala-Palau C, Albiol M, Ortega-Serrano J, Castro-Gutierrez E (2013) Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg 100(12):1597–1605. doi:10.1002/bjs.9252
L. Fernández-Cruz, R. Cosa, L. Blanco et al (2008) Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 248(6):930–938. doi:10.1097/SLA.0b013e31818fefc7
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(9):1111–1119
Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, Hyslop T, Schmidt CM, Rosato EL, Lavu H, Nakeeb A, Pitt HA, Lillemoe KD, Yeo CJ (2009) Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg 208(5):738–747. doi:10.1016/j.jamcollsurg.2008.12.031
Chen YJ, Lai EC, Lau WY, Chen XP (2014) Enteric reconstruction of pancreatic stump following pancreaticoduodenectomy: a review of the literature. Int J Surg 12(7):706–711. doi:10.1016/j.ijsu.2014.05.060
Sung JP, Steward RD, O’Hara VS et al (1997) A study of forty-nine consecutive Whipple resections for periampullary adenocarcinoma. Am J Surg 174:6–10
Aston SJ, Longmire WP Jr (1974) Management of the pancreas after pancreaticoduodenectomy. Ann Surg 179:322–327
Trede M, Schwall G (1988) The complications of pancreatectomy. Ann Surg 207(1):39–47
Winter JM, Cameron JL, Campbell KA et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210
Okamoto A, Tsuruta K (2000) Fistulation method: simple and safe pancreaticojejunostomy after pancreatoduodenectomy. Surgery 127(4):433–438
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All the authors confirm that all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Being a retrospective study, not involving experimental procedures, informed consent was not needed.
Rights and permissions
About this article
Cite this article
Alfieri, S., Quero, G., Rosa, F. et al. Indications and results of pancreatic stump duct occlusion after duodenopancreatectomy. Updates Surg 68, 287–293 (2016). https://doi.org/10.1007/s13304-016-0384-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-016-0384-x