Evidence for Roux-en-Y Pancreatic Duct Drainage Versus Standard Anastomosis in Pancreatic Transplantation
| Autor: | Martin Drage, James Goetz, Chris J Watson, Shruti Mittal, Richard Dumbill, Sanjay Sinha |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Duodenum Endocrinology Diabetes and Metabolism Jejunostomy Anastomosis Endocrinology Internal Medicine Clinical endpoint medicine Humans Registries Hepatology business.industry Anastomosis Surgical Graft Survival Hazard ratio Pancreatic Ducts Anastomosis Roux-en-Y Odds ratio Middle Aged medicine.disease Kidney Transplantation Survival Analysis Roux-en-Y anastomosis United Kingdom Confidence interval Surgery Transplantation surgical procedures operative Drainage Pancreatitis Female Pancreas Transplantation business |
| Zdroj: | Pancreas. 50:847-851 |
| ISSN: | 1536-4828 0885-3177 |
| Popis: | OBJECTIVES Pancreatic transplantation is usually performed simultaneously with renal transplantation in the setting of end-stage nephropathy and type 1 diabetes. Surgical methods for dealing with exocrine secretions include bladder drainage, direct duodenojejunostomy and Roux-en-Y (ReY) enteric drainage. Roux-en-Y may confer an advantage over duodenojejunostomy because it distances enteric content from the transplant duodenal anastomosis. We examined the effect of enteric drainage method on transplant outcomes. METHODS Data were obtained from the UK transplant registry on 2172 consecutive pancreatic transplants. Early graft loss was the primary endpoint. Secondary endpoints included return to theater, length of inpatient stay, readmission with pancreatitis, graft survival, and patient survival. RESULTS There was no protective effect of ReY drainage (early graft loss, 4.6% vs 3.1%, P = 0.30; hazard ratio, 0.98; 95% confidence interval, 0.63-1.52; P = 0.91). There was a significant association between ReY and return to theater, reflecting either the technique or indication for ReY (multivariate odds ratio, 2.05; 95% confidence interval, 1.38-3.06; P < 0.01). The effect of transplant center on graft survival was assessed and adjusted for. CONCLUSIONS There was no evidence of a protective benefit of ReY drainage over duodenojejunostomy, but there was an increased risk of return to theater. |
| Databáze: | OpenAIRE |
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