 |
|
Type of connection procedure after pancreatic surgery influenced rate of pancreatic fistula
May 01, 2009(PHILADELPHIA) After surgery to remove the head of the pancreas, invagination of the pancreas into the small intestine resulted in a lower rate of pancreatic fistula, according to researchers at the Jefferson Pancreas, Biliary and Related Cancer Center. The research was published in the Journal of the American College of Surgeons. It was performed as a randomized trial - the gold standard for studies.
Removing the head of the pancreas, a procedure called pancreaticoduodenectomy (PD), is a common treatment for benign and malignant pancreatic diseases. Pancreatic fistula, a leakage of pancreatic secretions, represents healing failure of the pancreatic reconnection. It is a common complication of PD, affecting approximately 20 percent of patients. The development of pancreatic fistula has been associated with several factors, including soft pancreas texture and surgical technique. It can result in prolonged hospitalization and other complications.
Prior to this study, the role of the type of pancreas-intestine reconnection procedure, known as pancreaticojejunostomy (PJ), in the development of pancreatic fistula had not been as well-studied , according to Adam Berger, M.D., associate professor in the department of Surgery of Jefferson Medical College at Thomas Jefferson University.
"We actually hypothesized that a duct-to-mucosa PJ procedure would result in fewer pancreatic fistulas," Dr. Berger said. "However, the rate of pancreatic fistula was almost double in patients who received the duct-to-mucosa PJ compared to the invagination PJ."
Dr. Berger and colleagues at Jefferson and Indiana University randomized 197 patients who were undergoing PD to receive either an invagination PJ or a duct-to-mucosa PJ. In the duct-to-mucosa cohort, the rate of pancreatic fistula was 24%. In the invagination cohort, the fistula rate was 12%. The greatest risk factor was pancreatic texture: 27% of patients with a soft gland developed pancreatic fistula, compared with 8% of patients with hard glands.
"There currently is no standard PJ performed after surgery, since the data have not indicated that one is better than the other for patients," Dr. Berger said. "These data suggest that invagination PJ may be the best choice."
Thomas Jefferson University
"We actually hypothesized that a duct-to-mucosa PJ procedure would result in fewer pancreatic fistulas," Dr. Berger said. "However, the rate of pancreatic fistula was almost double in patients who received the duct-to-mucosa PJ compared to the invagination PJ."
Dr. Berger and colleagues at Jefferson and Indiana University randomized 197 patients who were undergoing PD to receive either an invagination PJ or a duct-to-mucosa PJ. In the duct-to-mucosa cohort, the rate of pancreatic fistula was 24%. In the invagination cohort, the fistula rate was 12%. The greatest risk factor was pancreatic texture: 27% of patients with a soft gland developed pancreatic fistula, compared with 8% of patients with hard glands.
"There currently is no standard PJ performed after surgery, since the data have not indicated that one is better than the other for patients," Dr. Berger said. "These data suggest that invagination PJ may be the best choice."
Thomas Jefferson University
A new method of pancreaticojejunostomy?
A 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.
More Pancreatic Fistula Current Events and Pancreatic Fistula News Articles
|
Pancreatic Fistulas by Paolo Pederzoli (Editor), C. Bassi (Editor), S. Vesentini (Editor) This book is the result of the collaboration of many of the world's most renowned authorities in pancreatology, who have produced a comprehensive andup-to-date state of the art work on pancreatic fistulas, a complication of pancreatic diseases which is being recognized more and more frequently as experience with pancreatic diseases and surgery is increasing. Particular attention is paid to diagnosis and treatment, both medical and surgical, which nowadays allow the majority of the patientsto recover completely from this formerly often misdiagnosed and only empirically treated disease. | |
 |
2006 ANNUAL MEETING A.H.P.B.A DVD 09 AMERICAN HEPATO-PANCREATO-BILIARY ASSOCIATION/2006 Hepatology GENERAL POSTER SESSION: . The impact of margins on outcome following hepatic resection for colorrectal metastasis - Dr. Rowan Parks (UK) . IIC-Acetate in superior to 18F-Fluoroderyglucose (FDG) positron emisson tomography (PET) in evaluating patients with hepatocellular carcinoma - results of a pilot trial - Dr. C. Wright Pinson (USA) . Effect of extending-4 treatment in minimal islet mass transplant model in streptozotocin-induced diabetic mice - Dr. Davin Eckhoff (USA) . Clinical and economic validation of the international study group of pancreatic fistula (ISGPF) classification scheme - Dr. Claudio Bassi (Italy) GENERAL POSTER SESSION: . Extent of lymph node dissection and staging for extrahepatic cholangiocarcinomas -... |
|
Experimental studies on the external secretion of the pancreas with special reference to the effect of its complete loss by permanent pancreatic fistula by John Milton McCaughan (Author) | |
|
Progress in Fibrin Sealing by Hans-Werner Waclawiczek (Editor) This volume presents the experimental and clinical assessment of fibrin sealing in endoscopy. It is based on a Symposium held in Salzburg, December 1988 and updates information availabe since the first symposium held in Vienna, 1985. Results show that, since fibrin sealing came into clinical use 13 years ago, it has become an accepted tool in many fields of surgery and increased postoperative safety. The indications and limitations of new methods are discussed here, specifically, fibrin sealing for the endoscopic closure of broncho-pleural and gastro-intestinal fistulae, for the endoscopic hemostasis of bleeding gastro-duodenal ulcers, and for the occlusion of the pancreatic duct. | |
|
|
2006 ANNUAL MEETING A.H.P.B.A. - DVD 22 AMERICAN HEPATO-PANCREATO-BILIARY ASSOCIATION/2006 Hepatology AHPBA/PANCREAS CLUB JOINT SYMPOSIUM: Clinical severity of pancreatic anastomotic fistula . Evidence based medicine - incidence and definitons of leak - Dra. Keita Wada (Japan) . An international consensus for definition of pancreatic fistula - Dr. Claudio Bassi (Italy) AHPBA/PANCREAS CLUB JOINT SYMPOSIUM: Clinical severity of pancreatic anastomotic fistula |
| © 2009 BrightSurf.com |