Faculty Surgical Gastroenterology, Department of Surgery, Armed Forces Medical College, Pune 411040, India.
Faculty Surgical Gastroenterology, Department of Surgery, Armed Forces Medical College, Pune 411040, India.
Int J Surg. 2018 Feb;50:104-109. doi: 10.1016/j.ijsu.2017.12.015. Epub 2017 Dec 26.
The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy.
The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications.
The study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented.
There were 60 men and 37 women (mean age was 55.4 ± 11.6 years) with a mean BMI of 22.6 Kg/M. 16% of the patients had evidence of cholangitis and 14 of them had to be stented preoperatively. Ninety-four percent of the patients were operated for malignant cause of obstructive jaundice. The mean operative time was 283 min s and average blood loss during surgery was 352 ml. 36% of the patients were operated by the senior residents undergoing training in Gastro intestinal surgery with the assistance of the available faculty. 60% of the patients had a pancreatic duct diameter less than 3 mm. 72% of the pancreatic stump were soft in consistency. In our study we had 3% patients with pancreatic leak. The most frequent complication was DGE, which was seen in 22% patients. The mean duration of DGE was 13.5 ± 2.6 days. We had 2 deaths within 30 days of surgery of which one was due to massive intraabdominal bleed due to pancreatic leak. None of the parameters like pre-operative and operative parameters like age, bilirubin, total leucocyte count, preoperative stenting, pancreatic duct diameter, texture of pancreas and surgery performed by residents were found to be responsible for pancreatic leak.
This novel method of binding PG is simple, secure, and reproducible. It possesses several advantages over the conventional PG: it is very easy to perform, it is less traumatic to the pancreatic stump, can be performed in all types of pancreatic stump irrespective of the texture and diameter of the pancreatic duct without any statistically significant adverse outcomes.
胰十二指肠切除术后胰腺吻合术的类型通常归因于胰漏的原因。比较胰肠吻合术和胰胃吻合术的各种随机试验结果相互矛盾，一种方法优于另一种方法，反之亦然。在这项研究中，我们旨在通过分析胰十二指肠切除术后胰腺胃吻合术的一种新方法来批判性地分析该技术。
本研究的目的是通过评估绑定 PG 的技术方面来观察绑定胰腺胃吻合术的结果，并研究术后并发症的发生率。
这项研究包括 2012 年 3 月至 2016 年 3 月在一家三级保健医院接受绑定胰腺胃吻合术的所有患者。记录患者数据，包括患者的人口统计学、手术类型、并发症、死亡率、住院时间、术后介入性操作或再次手术。
共有 60 名男性和 37 名女性（平均年龄为 55.4±11.6 岁），平均 BMI 为 22.6 Kg/M。16%的患者有胆管炎证据，其中 14 例术前需要支架置入。94%的患者因恶性阻塞性黄疸而行手术治疗。平均手术时间为 283 分钟，术中平均出血量为 352 毫升。36%的患者由接受胃肠外科培训的高级住院医师在现有教职员工的协助下进行手术。60%的患者胰管直径小于 3mm。72%的胰腺残端质地柔软。在我们的研究中，我们有 3%的患者出现胰漏。最常见的并发症是 DGE，发生率为 22%。DGE 的平均持续时间为 13.5±2.6 天。我们有 3 例患者在术后 30 天内死亡，其中 1 例因胰漏导致大量腹腔内出血。术前和术中参数，如年龄、胆红素、总白细胞计数、术前支架置入、胰管直径、胰腺质地和住院医师手术，均与胰漏无关。
这种新的绑定 PG 方法简单、安全、可重复。它与传统的 PG 相比具有几个优点：它非常容易操作，对胰腺残端的创伤较小，可在所有类型的胰腺残端中进行，无论胰腺管的质地和直径如何，都不会产生任何具有统计学意义的不良后果。
