Peri-operative outcomes of pancreaticoduodenectomy comparing an isolated Roux loop or single loop for reconstruction: An ambispective observational study.

Autor: Jena SS; Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India. Electronic address: suvu1078@gmail.com., Mehta NN; Center for Digestive Sciences, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India., Yadav A; Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India., Nundy S; Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India.
Jazyk: angličtina
Zdroj: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] [Pancreatology] 2024 Aug; Vol. 24 (5), pp. 805-811. Date of Electronic Publication: 2024 May 26.
DOI: 10.1016/j.pan.2024.05.527
Abstrakt: Background: A post-operative pancreatic fistula is a major cause of morbidity and mortality in patients undergoing pancreaticoduodenectomy. We compared two methods of reconstruction of pancreaticojejunal anastomosis, an isolated loop with a single loop, to assess their effects on the incidence and severity of fistula.
Methods: The data was collected in an ambispective manner. The drain fluid was sent for amylase measurement on post-operative day 3 and a fistula was defined and classified according to the 2016 modification of the International Study Group for Pancreatic Surgery definition. The patients were divided into the isolated (Group I) and single (Group II) loop groups and compared for the incidence and severity of clinically relevant fistula along with other parameters.
Results: A total of 349 (Group I: 201, Group II: 148) patients were included in the study. The incidence of clinically relevant fistula was comparable (p = 0.206). Grade C fistula was found to be lower in the group I (7 % vs 11.6 %, p = 0.137), in patients with a soft pancreas (8.5 % vs 18.3 %, p = 0.049) and pancreatic duct diameter less than 5 mm (9.8 % vs 17.2 %, p = 0.036). The operative time was lower in Group I than in Group II (438 min vs 478, p < 0.001).
Conclusion: We found that the incidence of clinically relevant fistula was similar in both the groups but the isolated reconstruction method reduced the incidence of severe fistula. In patients with a smaller pancreatic duct, soft pancreas echotexture and obesity, it provides a safer alternative and can be performed in less time than a single loop reconstruction.
Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose.
(Copyright © 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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