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Intra‐arterial bolus octreotide administration during Whipple procedure in patients with fragile pancreas: A novel technique for safer pancreaticojejunostomy
Author(s) -
Konstadoulakis Manousos M.,
Filippakis George M.,
Lagoudianakis Emmanuel,
Antonakis Pantelis T.,
Dervenis Chris,
Bramis John
Publication year - 2005
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20193
Subject(s) - medicine , octreotide , anastomosis , pancreas , surgery , fistula , whipple procedure , pancreaticoduodenectomy , gastroduodenal artery , bolus (digestion) , periampullary cancer , radiology , artery , somatostatin
Background and Objectives Leakage from the pancreaticojujenostomy is the most serious complication of Whipple. Pancreatic fistula rate is higher in cases of fragile pancreas often seen in duodenal carcinomas and carcinomas of the ampulla of Vater. Octreotide administration has been used for the prevention of fistula formation through the subcutaneous route. Due to its physiologic effects to the pancreatic parenchyma the intra‐arterial administration of octreotide could provide tissue hardening that allows for a technically easier anastomosis while maintaining its protective role for fistula formation. Methods Octreotide was injected directly into the distal part of the gastroduodenal artery (GDA) in four patients undergoing Whipple for histologically proven periampullary cancer. Results Tissue hardening after octreotide administration was evident not only in surgeons' hands but in the intra‐operative ultrasound as well. The three patients were discharged on day 9, 11, and 13; they had an uneventful postoperative course, while one patient had a minor bile leak from the choledojejunal anastomosis and was discharged on day 22. Conclusions The intra‐arterial administration of octreotide during Whipple is a safe procedure and provides tissue hardening thus making the performance of the anastomosis technically easier. The actual benefit in terms of morbidity, mortality, and fistula rate are to be further evaluated. J. Surg. Oncol. 2005;89:268–272. © 2005 Wiley‐Liss, Inc.