Advance ligation to facilitate pancreaticojejunostomy following pancreaticoduodenectomy by dilating the main pancreatic duct
| Autor: | Kazuteru Monden, Go Wakabayashi, Masayoshi Hioki, Norihisa Takakura, Hiroshi Sadamori, Masayuki Honda |
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| Rok vydání: | 2021 |
| Předmět: |
Pancreatic duct
Pancreatic parenchyma business.industry medicine.medical_treatment Intraoperative ultrasonography medicine.disease Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure hemic and lymphatic diseases 030220 oncology & carcinogenesis medicine Pancreatitis Original Article 030211 gastroenterology & hepatology Surgery Single institution Nuclear medicine business Pancreas Ligation |
| Zdroj: | Gland Surg |
| ISSN: | 2227-8575 2227-684X |
| DOI: | 10.21037/gs-20-501 |
| Popis: | BACKGROUND: Duct-to-mucosa pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD) is technically challenging, particularly in cases of soft pancreas with a nondilated main pancreatic duct (MPD). We propose a novel procedure that involves ligating the pancreas in advance to allow for MPD dilation. METHODS: We compared the data of 16 patients who underwent PD followed by PJ with advance ligation (AL) for soft pancreas with a nondilated MPD with that of 17 patients who underwent a conventional procedure (conventional group) without AL at a single institution between January 2015 and April 2017. MPD diameters were assessed using preoperative computed tomography and intraoperative ultrasonography. Pancreatic consistency was judged intraoperatively. The pancreatic parenchyma and MPD were ligated in advance to allow time for MPD dilation. After AL, we divided the pancreatic parenchyma. AL led to MPD dilation and facilitated PJ. RESULTS: There were significantly fewer complications in the AL group than in the conventional group (P=0.005). There were no cases of pancreatitis or death in either group. The mean procedural time for occluding the MPD was 43 min (range, 21–134 min). The median MPD dilation rate after AL was 1.6 (0.9–3.8). CONCLUSIONS: AL is a simple, safe, and useful procedure for facilitating PJ. |
| Databáze: | OpenAIRE |
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