Pancreaticojejunal Bridge-Anastomosis: A Novel Option for Surgeon to Preserve Pancreatic Body and Tail in Urgent Reoperation for Intra-abdominal Massive Hemorrhage after Pancreaticoduodenectomy

Autor: Xiaobo Zhang, Xian-Wei Dai, Feng Gao, Xian-Min Bu, Jin Xu
Rok vydání: 2010
Předmět:
Zdroj: World Journal of Surgery. 34:2457-2462
ISSN: 1432-2323
0364-2313
DOI: 10.1007/s00268-010-0658-2
Popis: Postoperative intra-abdominal massive bleeding is a rare and life-threatening complication associated with pancreaticoduodenectomy. Completion pancreatectomy (CP) was usually performed during reexploration for the complication. The management could decrease the complications, such as the pancreatic leakage or intraluminal infection after reexploration, but could increase mortality during the perioperative period. It also could result in loss of pancreatic function forever. This study evaluated an alternative surgical management for intra-abdominal massive hemorrhage to prevent pancreas function, simplify the surgical processes, and decrease the mortality of relaparotomy. Outcome after pancreaticojejunal bridge-anastomosis (PJBA) performed between January 2006 and June 2009 was compared with that after CP performed between February 1984 and December 2005. Between February 1984 and June 2009, 963 patients underwent the Whipple procedure (PD) or pylorus-preserving pancreaticoduodectomy (PPPD). Pancreatic leakage occurred in 103 patients (10.7%); 22 cases (21.4%) developed into intra-abdominal massive bleeding. Nonsurgical procedures of transarterial embolization (TAE) were performed in ten (45.45%) patients, of whom one died (10%). Twelve (54.55%) underwent reoperation. Five had CP with one death (20%). Pancreatic remnant was preserved by pancreaticojejunal bridge-anastomosis (PJBA) in seven patients with no deaths. The reexploration time was 340 ± 48.2 min vs. 247.9 ± 40.8 min (P
Databáze: OpenAIRE
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