Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstructi...Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction （duct-to-mucosa versus invagination）, by meta-analysis and assessment of evidence quality. Methods Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials （RCTs） comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio （RR） or mean difference. Results From 321 identified abstracts, four RCTs （467 patients; duct-to-mucosa： 232; invagination： 235） were included. Pancreatic fistula rate （RR, 0.74; 95% confidence interval （C/）： 0.24-2.28; P=0.60）, mortality （RR, 1.18; 95% CI： 0.39- 3.54; P=0.77）, morbidity （RR, 0.91; 95% CI： 0.69-1.21; P=0.53）, reoperation （RR, 1.09; 95% CI： 0.54-2.22; P=-0.81） and hospital stay （mean difference, -1.78; 95% CI： -4.60-1.04; P=0.22） were similar between techniques. Conclusions Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.展开更多
AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct wit...AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture.METHODS: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis.RESULTS: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen.CONCLUSION: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.展开更多
Background:Clinically relevant postoperative pancreatic fistula(CR-POPF)is the most common and severe complication after pancreaticoduodenectomy(PD).Despite the development of numerous anastomotic surgical techniques ...Background:Clinically relevant postoperative pancreatic fistula(CR-POPF)is the most common and severe complication after pancreaticoduodenectomy(PD).Despite the development of numerous anastomotic surgical techniques to minimize CR-POPF,more than 30%of patients who undergo PD develop CR-POPF.Herein,we propose a novel pancreaticojejunostomy(PJ)technique and evaluate its efficacy and safety compared to traditional PJ.Methods:This retrospective study enrolled 164 consecutive patients who underwent PJ after PD between January 2012 and June 2017.Of them,78(47.6%)underwent traditional PJ and 86(52.4%)underwent sixstitch PJ.The primary outcome was CR-POPF at 1-month follow-up defined according to the revised 2016 International Study Group on Pancreatic Fistula definition.To adjust for baseline differences and selection bias,patients were matched by propensity scores,which left 63 patients with traditional PJ and 63 with six-stitch PJ.Results:Compared to patients who underwent traditional PJ(mean age 56.2±9.4 years),patients who underwent six-stitch PJ(mean age 57.4±11.4 years)had a lower CR-POPF rate.The risk of CR-POPF among patients who underwent six-stitch PJ was decreased by 81.7%after adjustment for age,sex,body mass index,and disease severity compared to patients who underwent traditional PJ.Additionally,the surgery time was reduced from 29 min for traditional PJ to 15 min for six-stitch PJ(P<0.001).Adverse effects such as abdominal fluid collection,abdominal bleeding,and wound infection were similar between two groups.Conclusion:Six-stitch PJ may be an effective and efficient PJ technique for patients who undergo PD surgery.展开更多
文摘Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction （duct-to-mucosa versus invagination）, by meta-analysis and assessment of evidence quality. Methods Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials （RCTs） comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio （RR） or mean difference. Results From 321 identified abstracts, four RCTs （467 patients; duct-to-mucosa： 232; invagination： 235） were included. Pancreatic fistula rate （RR, 0.74; 95% confidence interval （C/）： 0.24-2.28; P=0.60）, mortality （RR, 1.18; 95% CI： 0.39- 3.54; P=0.77）, morbidity （RR, 0.91; 95% CI： 0.69-1.21; P=0.53）, reoperation （RR, 1.09; 95% CI： 0.54-2.22; P=-0.81） and hospital stay （mean difference, -1.78; 95% CI： -4.60-1.04; P=0.22） were similar between techniques. Conclusions Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.
文摘AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture.METHODS: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis.RESULTS: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen.CONCLUSION: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.
基金supported by a grant from the National Natural Science Foundation of China(81571553)。
文摘Background:Clinically relevant postoperative pancreatic fistula(CR-POPF)is the most common and severe complication after pancreaticoduodenectomy(PD).Despite the development of numerous anastomotic surgical techniques to minimize CR-POPF,more than 30%of patients who undergo PD develop CR-POPF.Herein,we propose a novel pancreaticojejunostomy(PJ)technique and evaluate its efficacy and safety compared to traditional PJ.Methods:This retrospective study enrolled 164 consecutive patients who underwent PJ after PD between January 2012 and June 2017.Of them,78(47.6%)underwent traditional PJ and 86(52.4%)underwent sixstitch PJ.The primary outcome was CR-POPF at 1-month follow-up defined according to the revised 2016 International Study Group on Pancreatic Fistula definition.To adjust for baseline differences and selection bias,patients were matched by propensity scores,which left 63 patients with traditional PJ and 63 with six-stitch PJ.Results:Compared to patients who underwent traditional PJ(mean age 56.2±9.4 years),patients who underwent six-stitch PJ(mean age 57.4±11.4 years)had a lower CR-POPF rate.The risk of CR-POPF among patients who underwent six-stitch PJ was decreased by 81.7%after adjustment for age,sex,body mass index,and disease severity compared to patients who underwent traditional PJ.Additionally,the surgery time was reduced from 29 min for traditional PJ to 15 min for six-stitch PJ(P<0.001).Adverse effects such as abdominal fluid collection,abdominal bleeding,and wound infection were similar between two groups.Conclusion:Six-stitch PJ may be an effective and efficient PJ technique for patients who undergo PD surgery.
