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Interventional pancreaticojejunostomy after pancreatoduodenectomy

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Abstract

Background

Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy (PD) is closely associated with intra-abdominal hemorrhage with ensuing high mortality.

Methods

Interventional pancreaticojejunostomy was performed in 10 patients with external drainage of pancreatic juice after two-staged PD or leakage from pancreaticojejunostomy after PD. The jejunum was punctured using a 22-gauge needle into the pancreatic fistula during endoscopic observation of the jejunal lumen, followed by the insertion of two 0.35-inch guide-wires into the jejunum and pancreatic fistula. Finally, a stenting tube was placed between the jejunum and pancreatic fistula.

Results

No severe complications developed. Oral intake was instituted the following day in 8 of 10 patients, and on the 7th day in the remaining two patients.

Conclusion

This interventional procedure is considered to be safe and easy to perform, and in the future, it may permit a reduction in the number of second laparotomies in pancreatic fistula.

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References

  1. 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: 430–438

    Article  PubMed  CAS  Google Scholar 

  2. 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 

  3. Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR (2001) Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 33: 898–900

    Article  PubMed  CAS  Google Scholar 

  4. Kazanjian KK, Hines OJ, Eibl G, Reber HA (2005) Management of pancreatic fistulas after pancreaticoduodenectomy. Arch Surg 140: 849–855

    Article  PubMed  Google Scholar 

  5. Kubota K, Makuuchi M, Takayama T, Sakamoto Y, Harihara Y, Kimura W (2000) Appraisal of two-stage pancreatoduodenectomy: Its technical aspects and outcome. Hepatogastroenterology 47: 269–274

    PubMed  CAS  Google Scholar 

  6. Lerut JP, Gianello PR, Otte JB, Kestens PJ (1984) Pancreaticoduodenal resection: surgical experience and evaluation of risk factors in 103 patients. Ann Surg 199: 432–437

    Article  PubMed  CAS  Google Scholar 

  7. Martin FM, Rossi RL, Munson JL, ReMine SG, Braasch JW (1989) Management of pancreatic fistula. Arch Surg 124: 571–573

    PubMed  CAS  Google Scholar 

  8. Miyagawa S, Makuuchi M, Kawasaki S, Ogawa MP (1994) Second-staged pancreatojejunostomy following pancreatoduodenectomy in high-risk patients. Am J Surg 168: 66–68

    Article  PubMed  CAS  Google Scholar 

  9. Miyagawa S, Makuuchi M, Kawasaki S, Hayashi K, Harada H, Kitamura H, Seki H (1996) Outcome of major hepatectomy with pancreatoduodenectomy for advanced biliary malignancies. World J Surg 20: 77–80

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Shankar S, Russell RCG (1989) Hemorrhage in pancreatic disease. Br J Surg 76: 863–866

    Article  PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan

    Akihiro Cho

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  1. Akihiro Cho
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Correspondence to Akihiro Cho.

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Cho, A. Interventional pancreaticojejunostomy after pancreatoduodenectomy. Surg Endosc 21, 1032–1035 (2007). https://doi.org/10.1007/s00464-006-9046-2

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  • DOI: https://doi.org/10.1007/s00464-006-9046-2

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