| 篇名 |
Secure reconstruction after pancreaticoduodenectomy: Review and improved our continuous duct-to-mucosa anastomosis |
| 作者 |
Tsann-Long Hwang, Hao-Wei Kao, Chih-Po Hsu, Jun-Te Hsu, Chun-Nan Yeh, Ta-Sen Yeh |
| 卷期/出版年月 |
56卷1期 (2023/1) |
| 頁次 |
1-8 |
| 摘要 |
Pancreatic anastomotic leakage is the most common major complication after pancreaticoduodenectomy (PD). The incidence of pancreatic
anastomotic leak or fistula has declined to less than 20%, and mortality from this complication has decreased to less than 10% in recent
years. The ideal surgical procedures to achieve the most secure pancreaticojejunostomy were compared and reviewed. A
single-institution and personal experience was retrogradely compared with two periods between 1988 and 2017, which involved 121 patients
who were designed to compare the outcome of complications with or without pancreatic stump by four to six sutures before continuous
duct-to-mucosa PD. The surgical reconstruction technique was standardized and unique, and the pancreaticojejunal anastomosis
was created using the duct-to-mucosa without (group A, n = 62) and with (group B, n = 59) interrupted stump sutures. The rate of grade A
pancreatic fistula was 6.9% in group A and 0% in group B (P < 0.05). Postoperative mortality was 0% in group B. No patient underwent
reoperative PD due to pancreatic anastomotic leak. The length of stay during admission and after surgery was significant lower in group B,
which was due to less complication after surgery. Interrupted suture of pancreatic stump with a continuous duct-to-mucosa end-to-side
pancreaticojejunostomy plus external drainage is the best secure method for pancreaticojejunostomy after PD. |
| 關鍵詞 |
Continuous duct-to-mucosa technique; Pancreatic ductal adenocarcinoma; Pancreaticojejunostomy; Whipple operation |
| 分類 |
Review Article |
