Department of Surgery, UOC General and Oncological Surgery, AORN "S. Camillo-Forlanini", Rome, Italy.
Updates Surg. 2011 Dec;63(4):253-7. doi: 10.1007/s13304-011-0102-7. Epub 2011 Aug 18.
The authors describe the technique to perform a mechanical biliodigestive anastomosis after pancreatoduodenectomy that could be able to reduce the time of surgical intervention and the major systemic postoperative complication especially in elderly patients. Pancreaticoduodenectomy (PD) is considered to be the most effective procedure for the treatment of tumors of the pancreatic head and periampullary tumors. Postoperative morbidity remains high, reaching 40-50% in some series. Leakage and stricture of hepaticojejunal anastomosis have a special significance and occur in 2.5-5% of cases. The usefulness of mechanical staplers is well established in gastric and colorectal surgery, but their use in creating biliodigestive anastomosis is still a very controversial application. In the last 2 years (Nov 2008-Nov 2010), seven patients who underwent PD and presented at the time of operation, a main bile duct (MBD) greater of 20 mm, received a mechanical biliodigestive anastomosis with surgical stapler. All the patients were postoperatively controlled with an ultrasonography at 3 and 6 months, and a cholangio MRI at 1 year from operation. The follow up of the seven patients ranged from 3 to 18 months. Six patients are still alive and free of oncologic disease. One patient presented a single episode of cholangitis with a significant reduction of caliber of the biliodigestive anastomosis. The remaining five patients showed a good caliber of hepaticojejunal anastomosis. The authors suggest this procedure as a safe, feasible, more rapid and easier technique than traditional suture for bilioenteric anastomosis, when a suitable caliber of MBD allows to perform it.
作者描述了一种在胰十二指肠切除术后进行机械胆肠吻合的技术，该技术可以减少手术干预时间和主要的全身术后并发症，特别是在老年患者中。胰十二指肠切除术（PD）被认为是治疗胰头和壶腹周围肿瘤的最有效方法。术后发病率仍然很高，在一些系列中达到 40-50%。肝肠吻合口的渗漏和狭窄具有特殊意义，在 2.5-5%的病例中发生。在胃和结直肠手术中，机械吻合器的使用已经得到很好的证实，但在创建胆肠吻合术中的使用仍然是一个非常有争议的应用。在过去的 2 年（2008 年 11 月至 2010 年 11 月），7 名接受 PD 并在手术时出现主胆管（MBD）大于 20mm 的患者接受了机械胆肠吻合术。所有患者术后均在 3 个月和 6 个月进行超声检查，并在术后 1 年进行磁共振胆管成像（cholangio MRI）检查。7 名患者的随访时间从 3 个月到 18 个月不等。6 名患者仍然存活且无肿瘤疾病。1 名患者出现了单次胆管炎，胆肠吻合口的口径明显缩小。其余 5 名患者的肝肠吻合口口径良好。作者认为，当 MBD 的合适口径允许进行手术时，这种方法是一种安全、可行、更快且比传统缝合更简单的胆肠吻合技术。
