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Preliminary results of binding pancreaticojejunostomy.

Kim JM, Hong JB, Shin WY, Choe YM, Lee GY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.According to the post-operative course, 16 patients recovered well with no evidence of PF.The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University Hospital, Incheon, Korea.

ABSTRACT

Backgrounds/aims: The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.

Methods: We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines.

Results: Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management.

Conclusions: The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

No MeSH data available.


Related in: MedlinePlus

Presentation of morbidity and mortality cases. (A) Computed tomography 7 days after BPJ due to an ampulla of Vater cancer. There was a minimal amount of fluid collection in the subhepatic space. In the operative field, the pancreaticojejunostomy had become totally disrupted and there was bleeding at the cut surface of the pancreas. The patient underwent completion pancreatectomy. (B) Computed tomography at 11 days after pylorus-preserving pancreaticoduodenectomy due to distal bile duct cancer. There was a loculated hematoma with high attenuated fluid in the right subphrenic, subcapsular space and the right anterior pararenal spaces. This suggested extravasation of the contrast media with active bleeding. The patient received completion pancreatectomy, but he expired due to intraperitoneal abscess and multi-organ failure.
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Figure 2: Presentation of morbidity and mortality cases. (A) Computed tomography 7 days after BPJ due to an ampulla of Vater cancer. There was a minimal amount of fluid collection in the subhepatic space. In the operative field, the pancreaticojejunostomy had become totally disrupted and there was bleeding at the cut surface of the pancreas. The patient underwent completion pancreatectomy. (B) Computed tomography at 11 days after pylorus-preserving pancreaticoduodenectomy due to distal bile duct cancer. There was a loculated hematoma with high attenuated fluid in the right subphrenic, subcapsular space and the right anterior pararenal spaces. This suggested extravasation of the contrast media with active bleeding. The patient received completion pancreatectomy, but he expired due to intraperitoneal abscess and multi-organ failure.

Mentions: A patient who received total pancreatectomy for grade C PF after BPJ was a 75 year old man. He received PD due to cancer of the ampulla of Vater. Dilatation of the pancreas duct was identified and the texture of the pancreas was soft. He had diabetes mellitus, hypertension, and a surgical history of subtotal gastrectomy for ulcer perforation. Reoperation was performed on postoperative day 9 due to a hemoperitoneum. In the operation field, the pancreaticojejunostomy was totally disrupted and bleeding was found at the cut surface of the pancreas, and thus completion pancreatectomy was performed. He was discharged on postoperative day 66 (Fig. 2A).


Preliminary results of binding pancreaticojejunostomy.

Kim JM, Hong JB, Shin WY, Choe YM, Lee GY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Presentation of morbidity and mortality cases. (A) Computed tomography 7 days after BPJ due to an ampulla of Vater cancer. There was a minimal amount of fluid collection in the subhepatic space. In the operative field, the pancreaticojejunostomy had become totally disrupted and there was bleeding at the cut surface of the pancreas. The patient underwent completion pancreatectomy. (B) Computed tomography at 11 days after pylorus-preserving pancreaticoduodenectomy due to distal bile duct cancer. There was a loculated hematoma with high attenuated fluid in the right subphrenic, subcapsular space and the right anterior pararenal spaces. This suggested extravasation of the contrast media with active bleeding. The patient received completion pancreatectomy, but he expired due to intraperitoneal abscess and multi-organ failure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492331&req=5

Figure 2: Presentation of morbidity and mortality cases. (A) Computed tomography 7 days after BPJ due to an ampulla of Vater cancer. There was a minimal amount of fluid collection in the subhepatic space. In the operative field, the pancreaticojejunostomy had become totally disrupted and there was bleeding at the cut surface of the pancreas. The patient underwent completion pancreatectomy. (B) Computed tomography at 11 days after pylorus-preserving pancreaticoduodenectomy due to distal bile duct cancer. There was a loculated hematoma with high attenuated fluid in the right subphrenic, subcapsular space and the right anterior pararenal spaces. This suggested extravasation of the contrast media with active bleeding. The patient received completion pancreatectomy, but he expired due to intraperitoneal abscess and multi-organ failure.
Mentions: A patient who received total pancreatectomy for grade C PF after BPJ was a 75 year old man. He received PD due to cancer of the ampulla of Vater. Dilatation of the pancreas duct was identified and the texture of the pancreas was soft. He had diabetes mellitus, hypertension, and a surgical history of subtotal gastrectomy for ulcer perforation. Reoperation was performed on postoperative day 9 due to a hemoperitoneum. In the operation field, the pancreaticojejunostomy was totally disrupted and bleeding was found at the cut surface of the pancreas, and thus completion pancreatectomy was performed. He was discharged on postoperative day 66 (Fig. 2A).

Bottom Line: We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.According to the post-operative course, 16 patients recovered well with no evidence of PF.The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University Hospital, Incheon, Korea.

ABSTRACT

Backgrounds/aims: The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.

Methods: We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines.

Results: Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management.

Conclusions: The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

No MeSH data available.


Related in: MedlinePlus