Pancreaticoduodenectomy: a comparison of superior approach with classical Whipple's technique
| Autor: | Saleema Bano, Irfan Khan, Omar Javed Shah, Rayees Ahmad, Mushtaq A. Gagloo |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Blood transfusion medicine.medical_treatment Blood Loss Surgical Body Mass Index Pancreaticoduodenectomy Mesenteric Veins Postoperative Complications Risk Factors Humans Medicine Blood Transfusion Obesity Aged Retrospective Studies Aged 80 and over Chi-Square Distribution Hepatology Gastric emptying Portal Vein business.industry Gastroenterology Retrospective cohort study Length of Stay Middle Aged medicine.disease Surgery Pancreatic Neoplasms Dissection Treatment Outcome Pancreatic fistula Anesthesia Female business Body mass index Chi-squared distribution |
| Zdroj: | Hepatobiliary & Pancreatic Diseases International. 12:196-203 |
| ISSN: | 1499-3872 |
| DOI: | 10.1016/s1499-3872(13)60031-4 |
| Popis: | Background Pancreaticoduodenectomy (PD) is the standard procedure for resecting tumors arising from the periampullary area and the pancreatic head. Nevertheless this procedure is inherently difficult and associated with high morbidity and mortality. Besides, the technique applied for exposing the portal and superior mesenteric veins is time-consuming, difficult and associated with the risk of major venous injury. Recently we have introduced a modified approach for making this part of the procedure quick, safe and bloodless, which constitutes the subject of this study. Methods Patients who underwent pylorus preserving pancreaticoduodenectomy (PPPD) either by superior approach technique (group 1) or by classical Whipple's technique (group 2) were retrospectively identified. Age-sex composition, body mass index (BMI), total operative time, operative blood loss, intraoperative blood transfusion requirement, morbidity, mortality and length of hospital stay were compared between the two groups. Results Between January 1997 and December 2011, 72 patients underwent PPPD by the superior approach technique (group 1) and 38 underwent PPPD by the classical Whipple's technique (group 2) at our institution. Statistically significant differences were observed in operative time (208.1±46.3 minutes in group 1 vs 322.0±33.8 minutes in group 2), operative blood loss (601.0±250.3 mL in group 1 vs 1371.5±471.8 mL in group 2), and intraoperative blood transfusion requirement [10 (13.9%) patients in group 1 and 24 (63.2%) in group 2]. Among 18 (16.4%) obese patients, significant differences in operative time, operative blood loss and intraoperative blood transfusion requirement were observed between groups 1 and 2. There was no significant inter-group difference in complication rate among obese patients, but comparing obese patients with normal weight patients revealed higher rates of complications like pancreatic fistula (27.8% vs 6.5%), delayed gastric emptying (16.7% vs 5.4%), and infective complications like wound infection and intra abdominal collection (44.4% vs 5.4%). Conclusion On the basis of analytical data, we conclude that the superior approach technique is effective for PD compared with the classical Whipple's technique. It allows fast, safe and virtually bloodless dissection for exposure of the superior mesenteric and portal veins during early steps of PD. PD is normally a difficult and tedious procedure carrying a remote risk of major venous injury leading to substantial blood loss. |
| Databáze: | OpenAIRE |
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