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Short internal pancreatic stent reduces pancreatic fistula in pancreatoduodenectomy

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Abstract

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication of pancreatoduodenectomy (PD). A pancreatic stent is usually used for drainage of the pancreatic duct, but the best type of the stent remains unclear. The aim of this study was to investigate perioperative factors and their influence on the risk of CR-POPF following PD.

Methods

From 2006 to 2019, the records of 246 patients who underwent PD were retrospectively reviewed, and the relationship between perioperative factors including type of pancreatic stent and CR-POPF was investigated. External or internal pancreatic stents were used for drainage of the pancreatic duct, and the internal stent was inserted 1 cm into the jejunum to decrease stent obstruction.

Results

External and internal pancreatic stents were used in 137 and 109 patients, respectively. Multivariate analysis revealed that the diameter of the main pancreatic duct (odds ratio = 0.292, 95% confidence interval = 0.140–0.605, P = 0.001), diagnosis (odds ratio = 3.359, 95% confidence interval = 1.498–7.693, P = 0.003), and type of pancreatic stent (odds ratio = 0.435, 95% confidence interval = 0.203–0.934, P = 0.033) were independent factors related to CR-POPF after PD. Internal stent was associated with a low rate of CR-POPF (P < 0.001) and short postoperative hospital stay (P < 0.001) compared to external stent.

Conclusion

A short pancreatic internal stent could decrease the incidence of CR-POPF.

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Author information

Authors and Affiliations

  1. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan

    Teijiro Hirashita, Yukio Iwashita, Atsuro Fujinaga, Hiroaki Nakanuma, Kazuhiro Tada, Takashi Masuda, Yuichi Endo, Masayuki Ohta & Masafumi Inomata

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  1. Teijiro Hirashita
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  2. Yukio Iwashita
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  3. Atsuro Fujinaga
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  4. Hiroaki Nakanuma
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  5. Kazuhiro Tada
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  6. Takashi Masuda
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  7. Yuichi Endo
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  8. Masayuki Ohta
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  9. Masafumi Inomata
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Teijiro Hirashita, Atsuro Fujinaga, Hiroaki Nakanuma, Takashi Masuda, Yuichi Endo, and Masayuki Ohta. The first draft of the manuscript was written by Teijiro Hirashita, and critical revision of manuscript was performed by Yukio Iwashita and Masafumi Inomata. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Teijiro Hirashita.

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The authors declare that they have no conflict of interest.

Research involving human participants and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval (application no. 1447) was obtained before analysis of the data. Approval from the local ethics committee includes the usage and publication of those retrospectively analyzed data. Informed consent was obtained from all individual participants included in the study.

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Hirashita, T., Iwashita, Y., Fujinaga, A. et al. Short internal pancreatic stent reduces pancreatic fistula in pancreatoduodenectomy. Langenbecks Arch Surg 406, 721–728 (2021). https://doi.org/10.1007/s00423-020-02036-1

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  • DOI: https://doi.org/10.1007/s00423-020-02036-1

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