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A new method of pancreaticojejunostomy?
March 18, 2008A soft pancreatic texture with a narrow pancreatic ductal size creates a high risk for the development of a pancreatic fistula after pancreaticoduodenectomy, often leading to death. Several methods have been advocated to reduce the occurrence of leakage, but the best technique is still a subject of debate.
Leakage of the pancreaticoenterostomy remains a major cause of postoperative morbidity and mortality after pancreaticoduodenectomy. Many factors have been identified that are associated with an increased incidence of this complication. Among them, a small pancreatic ductal size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage.
A team led by Dr. Kenichi Hakamada from Hirosaki University, Japan, has, however, developed a new method of pancreaticojejunostomy with a fast-absorbable suture material, irradiated polyglactin 910, and a temporary stent tube to overcome the technical difficulties of performing a pancreaticoenterostomy of a soft pancreas with a narrow pancreatic duct.
In the view of the team, the key aspect of this method is the use of an irradiated polyglactin 910 suture and a temporary stent. In this method, complete external drainage of the pancreatic juice is secured for about 2 weeks by approximating the pancreatic duct and the jejunal mucosa with this fast-absorbable suture.
It has also been suggested that the incidence of a pancreatic fistula varies according to the definition. It is, therefore, quite important to use an internationally-accepted definition of pancreatic fistula to compare the different aspects of the new surgical method with the conventional one. By applying the four well-documented definitions strictly, the preliminary results of this novel method were well described by doctors from the Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan. The late surgical and nutritional outcomes were also reported.
Any conclusion for the surgical method needs to await randomization or a good cohort study, but the good early and late outcomes of this simple and easy-to-perform method seem to justify the carrying out of a randomized prospective study to compare this new method with appropriate controls.
World Journal of Gastroenterology
In the view of the team, the key aspect of this method is the use of an irradiated polyglactin 910 suture and a temporary stent. In this method, complete external drainage of the pancreatic juice is secured for about 2 weeks by approximating the pancreatic duct and the jejunal mucosa with this fast-absorbable suture.
It has also been suggested that the incidence of a pancreatic fistula varies according to the definition. It is, therefore, quite important to use an internationally-accepted definition of pancreatic fistula to compare the different aspects of the new surgical method with the conventional one. By applying the four well-documented definitions strictly, the preliminary results of this novel method were well described by doctors from the Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan. The late surgical and nutritional outcomes were also reported.
Any conclusion for the surgical method needs to await randomization or a good cohort study, but the good early and late outcomes of this simple and easy-to-perform method seem to justify the carrying out of a randomized prospective study to compare this new method with appropriate controls.
World Journal of Gastroenterology
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Pancreaticoduodenectomy: Webster's Timeline History, 1898 - 2007 by Icon Group International (Author) Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Pancreaticoduodenectomy," including when used in literature (e.g. all authors that might have Pancreaticoduodenectomy in their name). As such, this book represents the largest compilation of timeline events associated with Pancreaticoduodenectomy when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage. These furthermore cover all parts of speech (possessive, institutional usage, geographic usage) and contexts, including... |
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