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Three hundred and sixty‐eight consecutive pancreaticoduodenectomies with zero mortality
Author(s) -
Oguro Seiji,
Yoshimoto Jiro,
Imamura Hiroshi,
Ishizaki Yoichi,
Kawasaki Seiji
Publication year - 2017
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.433
Subject(s) - pancreaticoduodenectomy , medicine , pancreatic fistula , surgery , jejunostomy , perioperative , gastroduodenal artery , mortality rate , fistula , general surgery , artery , pancreas , resection , parenteral nutrition
Abstract Background Only a limited number of reports have documented zero mortality in consecutive pancreaticoduodenectomy series. The aim of this study is to review and verify our management aiming to eliminate mortality after pancreaticoduodenectomy. Methods Three hundred and sixty‐eight consecutive patients undergoing pancreaticoduodenectomy between 2002 and 2015 were retrospectively reviewed. During this period, in order to enhance the safety of pancreaticoduodenectomy, we have used a consistent strategy consisting of early ligation of the inferior pancreatoduodenal artery, mucosal sutureless pancreaticojejunostomy combined with external pancreatic duct stenting, conditional two‐stage pancreaticojejunostomy, jejunal decompression using tube jejunostomy, application of an omental flap to cover the stump of the gastroduodenal artery, and careful postoperative drain management. Results Major postoperative complications (Clavien‐Dindo grade ≥ III a) occurred in 20 patients (5%). Grade A/B/C pancreatic fistula was observed in 49/29/4 patients (13%/8%/1%), respectively. Reoperation and readmission was necessary in five and four patients (1% and 1%), respectively. There was no in‐hospital or 90‐day mortality. Conclusions To achieve zero mortality in pancreaticoduodenectomy, it is crucial to incorporate various strategies to minimize the degree of surgical invasiveness and the damage caused by pancreatic fistula with a meticulous approach to perioperative management.