Background: Postoperative morbidity remains a significant problem after pancreatico-duodenectomy. The management of pancreatic stump continues to be a challenge, and many technical solutions have been developed over the years. In this study, we report the results obtained with the use of an isolated loop for pancreatico-jejunostomy in patients with soft pancreas and small pancreatic duct diameter. Methods: Clinical data of patients submitted to pancreatico-duodenectomy in a period of sixteen years (2005–2020) were extracted from a prospective database. Patients with soft pancreas, main duct diameter < 2 mm and reconstruction by pancreatico-jejunostomy on single loop or isolated loop were selected. Primary end-point was the incidence of clinically relevant fistulas in the two groups of patients. Secondary endpoint was the length of postoperative hospital stay. A propensity score matching analysis was used for the statistics. Results: Two hundred and twenty-one patients with the above characteristics were found in the database. One hundred and twelve of these received a single-loop reconstruction and 109 an isolated loop reconstruction. Incidence of clinically relevant fistulas was higher in the first group (41% vs 27%; p = 0.023). Postoperative hospital stay was significantly shorter in the second group (21 days vs 15; p < 0.001). These results were confirmed at the propensity score matching. Conclusion: In patients with soft pancreatic texture and small main duct diameter, pancreatico-jejunostomy on isolated loop is associated with a lower incidence of clinically relevant fistulas than after classic reconstruction. The duration of postoperative hospital stay was significantly reduced, with consequent reduction of cost.

Clemente, G., De Rose, A. M., Panettieri, E., Ardito, F., Murazio, M., Nuzzo, G., Giuliante, F., Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?, <<JOURNAL OF GASTROINTESTINAL SURGERY>>, 2022; 2022 (N/A): N/A-N/A. [doi:10.1007/s11605-022-05296-y] [http://hdl.handle.net/10807/199162]

Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?

Clemente, G.
Primo
;
De Rose, A. M.;Panettieri, E.;Ardito, F.;Murazio, M.;Nuzzo, G.;Giuliante, F.
Ultimo
2022

Abstract

Background: Postoperative morbidity remains a significant problem after pancreatico-duodenectomy. The management of pancreatic stump continues to be a challenge, and many technical solutions have been developed over the years. In this study, we report the results obtained with the use of an isolated loop for pancreatico-jejunostomy in patients with soft pancreas and small pancreatic duct diameter. Methods: Clinical data of patients submitted to pancreatico-duodenectomy in a period of sixteen years (2005–2020) were extracted from a prospective database. Patients with soft pancreas, main duct diameter < 2 mm and reconstruction by pancreatico-jejunostomy on single loop or isolated loop were selected. Primary end-point was the incidence of clinically relevant fistulas in the two groups of patients. Secondary endpoint was the length of postoperative hospital stay. A propensity score matching analysis was used for the statistics. Results: Two hundred and twenty-one patients with the above characteristics were found in the database. One hundred and twelve of these received a single-loop reconstruction and 109 an isolated loop reconstruction. Incidence of clinically relevant fistulas was higher in the first group (41% vs 27%; p = 0.023). Postoperative hospital stay was significantly shorter in the second group (21 days vs 15; p < 0.001). These results were confirmed at the propensity score matching. Conclusion: In patients with soft pancreatic texture and small main duct diameter, pancreatico-jejunostomy on isolated loop is associated with a lower incidence of clinically relevant fistulas than after classic reconstruction. The duration of postoperative hospital stay was significantly reduced, with consequent reduction of cost.
Inglese
Clemente, G., De Rose, A. M., Panettieri, E., Ardito, F., Murazio, M., Nuzzo, G., Giuliante, F., Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?, <<JOURNAL OF GASTROINTESTINAL SURGERY>>, 2022; 2022 (N/A): N/A-N/A. [doi:10.1007/s11605-022-05296-y] [http://hdl.handle.net/10807/199162]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/199162
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