Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy
Background:. Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients’ outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuratio...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2022-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000161 |
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| author | Vasileios Smyrniotis, MD, PhD Stavros Parasyris, MD Georgios Gemenetzis, MD Ioannis Margaris, MD Zoe Petropoulou, MD Maria Papadoliopoulou, MD Theodoros Sidiropoulos, MD Dionysios Dellaportas, MD, PhD Antonios Vezakis, MD, PhD Andreas Polydorou, MD, PhD Panagiotis Kokoropoulos, MD, MSc Kassiani Theodoraki, MD, PhD Paraskevi Matsota, MD, PhD Panteleimon Vassiliu, MD, PhD, FACS, FASCRS Nikolaos Arkadopoulos, MD, PhD, FACS |
| author_facet | Vasileios Smyrniotis, MD, PhD Stavros Parasyris, MD Georgios Gemenetzis, MD Ioannis Margaris, MD Zoe Petropoulou, MD Maria Papadoliopoulou, MD Theodoros Sidiropoulos, MD Dionysios Dellaportas, MD, PhD Antonios Vezakis, MD, PhD Andreas Polydorou, MD, PhD Panagiotis Kokoropoulos, MD, MSc Kassiani Theodoraki, MD, PhD Paraskevi Matsota, MD, PhD Panteleimon Vassiliu, MD, PhD, FACS, FASCRS Nikolaos Arkadopoulos, MD, PhD, FACS |
| author_sort | Vasileios Smyrniotis, MD, PhD |
| collection | DOAJ |
| description | Background:. Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients’ outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients’ outcome.
Methods:. The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed.
Results:. Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively (P = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively (P = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively (P = 0.02 A vs B+C).
Conclusion:. Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH. |
| first_indexed | 2024-03-12T12:19:42Z |
| format | Article |
| id | doaj.art-7129353f9ce2405e91820eb1252d5710 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:42Z |
| publishDate | 2022-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-7129353f9ce2405e91820eb1252d57102023-08-30T06:09:59ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-06-0132e16110.1097/AS9.0000000000000161202206000-00015Severity of Pancreatic Leak in Relation to Gut Restoration After PancreaticoduodenectomyVasileios Smyrniotis, MD, PhD0Stavros Parasyris, MD1Georgios Gemenetzis, MD2Ioannis Margaris, MD3Zoe Petropoulou, MD4Maria Papadoliopoulou, MD5Theodoros Sidiropoulos, MD6Dionysios Dellaportas, MD, PhD7Antonios Vezakis, MD, PhD8Andreas Polydorou, MD, PhD9Panagiotis Kokoropoulos, MD, MSc10Kassiani Theodoraki, MD, PhD11Paraskevi Matsota, MD, PhD12Panteleimon Vassiliu, MD, PhD, FACS, FASCRS13Nikolaos Arkadopoulos, MD, PhD, FACS14From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece† Hepatobiliary and Pancreatic Unit, Royal Infirmary Edinburgh, Edinburgh, United KingdomFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece§ Department of Anesthesiology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece‖ Department of Anesthesiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceFrom the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GreeceBackground:. Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients’ outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients’ outcome. Methods:. The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed. Results:. Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively (P = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively (P = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively (P = 0.02 A vs B+C). Conclusion:. Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH.http://journals.lww.com/10.1097/AS9.0000000000000161 |
| spellingShingle | Vasileios Smyrniotis, MD, PhD Stavros Parasyris, MD Georgios Gemenetzis, MD Ioannis Margaris, MD Zoe Petropoulou, MD Maria Papadoliopoulou, MD Theodoros Sidiropoulos, MD Dionysios Dellaportas, MD, PhD Antonios Vezakis, MD, PhD Andreas Polydorou, MD, PhD Panagiotis Kokoropoulos, MD, MSc Kassiani Theodoraki, MD, PhD Paraskevi Matsota, MD, PhD Panteleimon Vassiliu, MD, PhD, FACS, FASCRS Nikolaos Arkadopoulos, MD, PhD, FACS Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy Annals of Surgery Open |
| title | Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy |
| title_full | Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy |
| title_fullStr | Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy |
| title_full_unstemmed | Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy |
| title_short | Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy |
| title_sort | severity of pancreatic leak in relation to gut restoration after pancreaticoduodenectomy |
| url | http://journals.lww.com/10.1097/AS9.0000000000000161 |
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