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Isolated R oux‐en‐ Y anastomosis of the pancreatic stump in a duct‐to‐mucosa fashion in patients with distal pancreatectomy with en‐bloc celiac axis resection
Author(s) -
Okada Kenichi,
Kawai Manabu,
Tani Masaji,
Hirono Seiko,
Miyazawa Motoki,
Shimizu Atsushi,
Kitahata Yuji,
Yamaue Hiroki
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.16
Subject(s) - medicine , pancreatic fistula , anastomosis , pancreatectomy , pancreatic duct , surgery , fistula , distal pancreatectomy , resection , pancreas , pancreatitis
Abstract Background A pancreatic fistula is one of the most serious complications in distal pancreatectomy with en bloc celiac axis resection ( DP‐CAR ), because the pancreatic transection is performed on the right side of the portal vein, which results in a large cross‐section surface, and because post‐pancreatectomy hemorrhage is hard to treat by interventional radiology. Therefore, a procedure to decrease the incidence of postoperative pancreatic fistula is urgently needed. Methods Twenty‐six consecutive patients who underwent DP‐CAR between A pril 2008 and A ugust 2012 were reviewed retrospectively. The first 13 consecutive patients underwent DP‐CAR with no anastomosis, and the subsequent 13 consecutive patients were treated with R oux‐en‐ Y pancreaticojejunostomy ( PJ ) in a duct‐to‐mucosa fashion. Results Extremely high amylase levels (>4000 IU/l) of all drainage fluid specimens on postoperative day ( POD ) 1, 3 and 4 were detected more frequently in cases with no anastomosis ( n = 7) compared to those with PJ ( n = 1) ( P = 0.056). Conclusion The incidence of grade B / C pancreatic fistulas was 15.4% in cases with isolated R oux‐en‐ Y anastomosis of the pancreatic stump performed in a duct‐to‐mucosa fashion, and we are currently examining whether this anastomosis method reduces the pancreatic fistula rate in a multicenter, randomized controlled trial for distal pancreatectomy patients ( C linical T rials.gov NCT 01384617).