Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study
Abstract Background Pancreatic fistula remains the biggest problem in pancreatic surgery. We have previously reported a new pancreatojejunostomy method using an inter-anastomosis drainage (IAD) suction tube with Blumgart anastomosis for drainage of the pancreatic juice leaking from the branched panc...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-022-01669-x |
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| author | Osamu Shimomura Tatsuya Oda Yoshihiro Miyazaki Kinji Furuya Manami Doi Kazuhiro Takahashi Jaejeong Kim Shoko Moue Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Tsuyoshi Enomoto Shinji Hashimoto |
| author_facet | Osamu Shimomura Tatsuya Oda Yoshihiro Miyazaki Kinji Furuya Manami Doi Kazuhiro Takahashi Jaejeong Kim Shoko Moue Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Tsuyoshi Enomoto Shinji Hashimoto |
| author_sort | Osamu Shimomura |
| collection | DOAJ |
| description | Abstract Background Pancreatic fistula remains the biggest problem in pancreatic surgery. We have previously reported a new pancreatojejunostomy method using an inter-anastomosis drainage (IAD) suction tube with Blumgart anastomosis for drainage of the pancreatic juice leaking from the branched pancreatic ducts. This study aimed to evaluate the postoperative outcomes of our novel method, in pancreatojejunostomy and investigate the nature of the inter-anastomosis space between jejunal wall and pancreas parenchyma. Methods This retrospectively study consist of 282 pancreatoduodenectomy cases, including 86 reconstructions via the Blumgart method plus IAD (B + IAD group) and 196 cases reconstructed using the Blumgart method alone (B group). Postoperative outcomes and the amylase value and the volume of the drainage fluids were compared between the two groups. The IAD tube was placed to collect amylase-rich fluid from the inter-anastomosis space during operative procedure between the jejunal wall and pancreatic stump. Results The daily IAD drainage volume and the amylase level was significantly higher in patients with a soft pancreas (vs hard pancreas; 16.5 vs. 10.0 mL/day, p = 0.012; 90,900 vs. 1634 IU/L, p < 0.001, respectively). The mean amylase value of IAD collection in 86 cases of B + IAD group was 63,100 IU/L. The incidence of clinically relevant pancreatic fistula grade B and C (23.2% vs. 23.0%, p = 0.55) and the hospital stay was similar between the groups (median 17 vs. 18 days, p = 0.55). In 176 patients with soft pancreas, the incidence of pancreatic fistula grade B and C (33.3% vs. 35.3%, p = 0.67) and the hospital stay was also similar between the groups (median 22.5 vs. 21 days, p = 0.81). Conclusions Positive effect of the IAD method observed in the pilot cases was not reproduced in the current study. IAD tube objectively demonstrated the existence of amylase-rich discharge at the anastomosis site, and countermeasures to eliminate this liquid are highly desired for preventing pancreatic fistula, especially in patients with soft pancreatic texture. Trial registration Retrospectively registered |
| first_indexed | 2024-12-10T23:24:07Z |
| format | Article |
| id | doaj.art-82d281ead4ac484889036319e8a96b86 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-10T23:24:07Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-82d281ead4ac484889036319e8a96b862022-12-22T01:29:38ZengBMCBMC Surgery1471-24822022-07-0122111010.1186/s12893-022-01669-xPancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational studyOsamu Shimomura0Tatsuya Oda1Yoshihiro Miyazaki2Kinji Furuya3Manami Doi4Kazuhiro Takahashi5Jaejeong Kim6Shoko Moue7Yohei Owada8Koichi Ogawa9Yusuke Ohara10Yoshimasa Akashi11Tsuyoshi Enomoto12Shinji Hashimoto13Department of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaDepartment of Surgery, Clinical Sciences, Faculty of Medicine, University of TsukubaAbstract Background Pancreatic fistula remains the biggest problem in pancreatic surgery. We have previously reported a new pancreatojejunostomy method using an inter-anastomosis drainage (IAD) suction tube with Blumgart anastomosis for drainage of the pancreatic juice leaking from the branched pancreatic ducts. This study aimed to evaluate the postoperative outcomes of our novel method, in pancreatojejunostomy and investigate the nature of the inter-anastomosis space between jejunal wall and pancreas parenchyma. Methods This retrospectively study consist of 282 pancreatoduodenectomy cases, including 86 reconstructions via the Blumgart method plus IAD (B + IAD group) and 196 cases reconstructed using the Blumgart method alone (B group). Postoperative outcomes and the amylase value and the volume of the drainage fluids were compared between the two groups. The IAD tube was placed to collect amylase-rich fluid from the inter-anastomosis space during operative procedure between the jejunal wall and pancreatic stump. Results The daily IAD drainage volume and the amylase level was significantly higher in patients with a soft pancreas (vs hard pancreas; 16.5 vs. 10.0 mL/day, p = 0.012; 90,900 vs. 1634 IU/L, p < 0.001, respectively). The mean amylase value of IAD collection in 86 cases of B + IAD group was 63,100 IU/L. The incidence of clinically relevant pancreatic fistula grade B and C (23.2% vs. 23.0%, p = 0.55) and the hospital stay was similar between the groups (median 17 vs. 18 days, p = 0.55). In 176 patients with soft pancreas, the incidence of pancreatic fistula grade B and C (33.3% vs. 35.3%, p = 0.67) and the hospital stay was also similar between the groups (median 22.5 vs. 21 days, p = 0.81). Conclusions Positive effect of the IAD method observed in the pilot cases was not reproduced in the current study. IAD tube objectively demonstrated the existence of amylase-rich discharge at the anastomosis site, and countermeasures to eliminate this liquid are highly desired for preventing pancreatic fistula, especially in patients with soft pancreatic texture. Trial registration Retrospectively registeredhttps://doi.org/10.1186/s12893-022-01669-xBlumgartDrainagePancreatic FistulaPancreatoduodenectomyPancreatojejunostomy |
| spellingShingle | Osamu Shimomura Tatsuya Oda Yoshihiro Miyazaki Kinji Furuya Manami Doi Kazuhiro Takahashi Jaejeong Kim Shoko Moue Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Tsuyoshi Enomoto Shinji Hashimoto Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study BMC Surgery Blumgart Drainage Pancreatic Fistula Pancreatoduodenectomy Pancreatojejunostomy |
| title | Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study |
| title_full | Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study |
| title_fullStr | Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study |
| title_full_unstemmed | Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study |
| title_short | Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study |
| title_sort | pancreatic juice outflow in pancreatojejunostomy monitoring with the inter anastomosis drainage tube a retrospective observational study |
| topic | Blumgart Drainage Pancreatic Fistula Pancreatoduodenectomy Pancreatojejunostomy |
| url | https://doi.org/10.1186/s12893-022-01669-x |
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