Skip to main content

Advertisement

Log in

Indications and results of pancreatic stump duct occlusion after duodenopancreatectomy

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cameron JL, Pitt HA, Yeo CJ et al (1993) One-hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 217:430–438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Trede M, Schwall G, Saeger H-D (1990) Survival after pancreaticoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg 211:447–458

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Schoretsanitis GN, Tsiftsis DD, Tatoulis PA et al (1993) Pancreaticoduodenectomy with external drainage of the residual pancreatic duct. Eur J Surg 159:421–424

    CAS  PubMed  Google Scholar 

  10. Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Aranha GV, Hodul P, Golts E et al (2003) A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 7:672–682

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Roder JD, Stein HJ, Bottcher KA et al (1999) Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: A prospective study. Ann Surg 229:41–48

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Greene BS, Loubeau JM, Peoples JB et al (1991) Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg 161:45–50

    Article  Google Scholar 

  16. Poon RT, Lo SH, Fong D et al (2002) Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg 183:42–52

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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

  21. 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

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  25. 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

    Article  CAS  PubMed  Google Scholar 

  26. Shrikehande SV, Qureshi SS, Rajneesh N et al (2005) Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies. World J Surg 29:1642–1649

    Article  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. Sato N, Yamaguchi K, Chijiiwa K et al (1998) Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 133:1094–1098

    Article  CAS  PubMed  Google Scholar 

  29. Marcus SG, Cohen H, Ranson JHC (1995) Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 221:635–648

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. 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

    CAS  PubMed  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. Stapleton GN, Williamson RC (1996) Proximal pancreatoduodenectomy for chronic pancreatitis. Br J Surg 83(10):1433–1440

  33. 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

  34. Ihse I, Anderson H, Andrén-Sandberg (1996) Total pancreatectomy for cancer of the pancreas: is it appropriate? World J Surg 20(3):288–293

  35. 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

  36. 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

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. 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

    Article  PubMed  Google Scholar 

  40. 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

    Article  CAS  PubMed  Google Scholar 

  41. Aston SJ, Longmire WP Jr (1974) Management of the pancreas after pancreaticoduodenectomy. Ann Surg 179:322–327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Trede M, Schwall G (1988) The complications of pancreatectomy. Ann Surg 207(1):39–47

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. Okamoto A, Tsuruta K (2000) Fistulation method: simple and safe pancreaticojejunostomy after pancreatoduodenectomy. Surgery 127(4):433–438

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Battista Doglietto.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-016-0384-x

Keywords

Navigation