Effect of Inner Diameter of Pancreatic Duct Following Pancreaticoduodenectomy on Pancreatic Fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XI Pengcheng , SHI Kaiwang , YANG Kunxing.

Department of General Surgery, Nanjing First Hospitol Affiliated to Nanjing Medical University, Nanjing 210006, China;

Corresponding author：

Keywords：

Inner diameter of pancreatic duct; Pancreaticoduodenectomy; Complication; Pancreatic fistula

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the effect of inner diameter of pancreatic duct following pancreaticoduodenectomy on pancreatic fistula.
Methods From January 1995 to December 2008, 256 patients underwent pancreaticoduodenectomy were divided into four groups based on the types of pancreaticojejunostomy: end-to-side “mucosa-to-mucosa” anastomosis group (n=115), end-to-end “mucosa-to-mucosa” anastomosis group (n=71), end-to-end invaginated pancreaticojejunostomy group (n=43) and pancreaticogastrostomy group (n=27). Alternatively, 238 patients were divided into two groups according to drainage ways: stenting tube for internal drainage group (n=132) and stenting tube for external drainage group (n=106). Furthermore, 233 cases were divided into three groups on the basis of inner diameter of pancreatic duct: ≤0.2 cm group (n=54), 0.2-0.4 cm group (n=93) and ≥0.4 cm group (n=76). Then, the incidence rate of pancreatic fistula of each group was compared.
Results The incidence of pancreatic fistula was 8.20% (21/256). The incidence of pancreatic fistula for different types of pancreaticojejunostomy was as follow: end-to-side “mucosa-to-mucosa” anastomosis group (7.83%， 9/115), end-to-end “mucosa-to-mucosa” anastomosis group (7.04%, 5/71), end-to-end pancreaticogastrostomy invaginated group (13.95%, 6/43) and pancreaticogastrostomy group (3.70%, 1/27), in which there wasn’t significant difference in 4 groups （χ2=2.763，P=0.430）. There was no significant difference of the incidence of pancreatic fistula between stenting tube for internal drainage group (9.10%, 12/132) and stenting tube for external drainage group (8.49%, 9/106), χ2=0.126, P=0.722. The incidence of pancreatic fistula in ≥0.4 cm group, 0.2-0.4 cm group and ≤0.2 cm group was respectively 0, 15.05% (14/93) and 11.11%(6/54), and the difference was significant (χ2=12.009, P=0.002). No correlation was found between the incidence of pancreatic fistula of different inner diameter of pancreatic duct and the types of pancreaticojejunostomy (χ2=1.878， P=0.598).
Conclusion The inner diameter of pancreatic duct is an important factor for postoperative pancreatic fistula. No relationship is found between the types of pancreaticojejunostomy and pancreatic fistula in this study.

Citation： XI Pengcheng,SHI Kaiwang,YANG Kunxing.. Effect of Inner Diameter of Pancreatic Duct Following Pancreaticoduodenectomy on Pancreatic Fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(8): 609-612. doi: Copy

1.	Oussoultzoglou E, Bachellier P, Bigourdan JM, et al. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy [J]. Arch Surg, 2004; 139(3): 327-335.
2.	Ibrahim S, Tay KH, Launois B, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy [J]. Dig Surg, 2006; 23(5-6): 296-302.
3.	Peng SY, Wang JW, Lau WY, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial [J]. Ann Surg, 2007; 245(5): 692-698.
4.	Nakao A, Fujii T, Sugimoto H, et al. Is pancreaticogastrostomy safer than pancreaticojejunostomy? [J]. J Hepatobiliary Pancreat Surg, 2006; 13(3): 202-206.
5.	Yoe CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy [J]. Ann Surg, 1995; 222(4): 580-592.
6.	Ohwada S, Tanahashi Y, Ogawa T, et al. In situ vs ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with billroth Ⅰ-type reconstruction [J]. Arch Surg, 2002; 137(11): 1289-1293.
7.	Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [J]. J Gastrointest Surg, 2004; 8(8): 951-959.
8.	李海民, 窦科峰, 宋振顺, 等. 套入式双层连续缝合加捆绑在胰肠吻合术中的应用 [J]. 中国普外基础与临床杂志, 2007; 14(4): 480.
9.	彭淑牖, 吴育连, 彭承宏, 等. 捆绑式胰肠吻合术(附28例报告) [J]. 中华外科杂志, 1997; 35(3): 158-159.
10.	张春秋, 王国华, 彭晓晖, 等. 捆绑式胰肠吻合术在预防胰十二指肠切除术后胰瘘发生中的临床应用 [J]. 中国普外基础与临床杂志, 2008; 15(8): 565-566.
11.	Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy [J]. Ann Surg, 1995; 221(6): 635-645.
12.	Greene BS, Loubeau JM, Peoples JB, et al. Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? [J]. Am J Surg, 1991; 161(1): 45-50.
13.	王志军, 吴阳, 彭启平, 等. 胰十二指肠切除术后发生胰瘘的危险因素 [J]. 中国普外基础与临床杂志, 2005; 12(4): 403-405.
14.	Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial [J]. J Am Coll Surg, 2009; 208(5): 738-749.
15.	时开网, 杨坤兴, 倪绍忠, 等. 胰十二指肠切除59例临床分析 [J]. 江苏医药杂志, 2003; 29(1): 29-30.
16.	Lemaire E, O’Toole D, Sauvanet A, et al. Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis [J]. Br J Surg, 2000; 87(4): 434-438.
17.	Amano H, Takada T, Ammori BJ, et al. Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study [J]. Hepatogastroenterology, 1998; 45(24): 2382-2387.
18.	Kurosaki I, Hatakeyama K, Kobayashi T, et al. Pancreaticogastrostomy: unreliable long-term pancreatic duct patency [J]. Hepatogastroenterology, 2003; 50(50): 545-549.
19.	Staley CA, Lee JE, Cleary KR, et al. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head [J]. Am J Surg, 1996; 171(1): 118-125.
20.	叶春, 席鹏程, 胡先贵. 胰腺钩突部癌的临床特征和诊断治疗 [J]. 中华外科杂志, 2002; 40(10): 766-768.
21.	Fischer CP, Bass B, Fahy B, et al. Transampullary pancreatic duct stenting decreases pancreatic fistula rate following left pancreatectomy [J]. Hepatogastroenterology, 2008; 55(81): 244-248.
22.	Winter JM, Cameron JL, Campbell KA, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial [J]. J Gastrointest Surg, 2006; 10(9): 1280-1290.
23.	Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial [J]. Ann Surg, 2007; 246(3): 425-435.

1. Oussoultzoglou E, Bachellier P, Bigourdan JM, et al. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy [J]. Arch Surg, 2004; 139(3): 327-335.
2. Ibrahim S, Tay KH, Launois B, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy [J]. Dig Surg, 2006; 23(5-6): 296-302.
3. Peng SY, Wang JW, Lau WY, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial [J]. Ann Surg, 2007; 245(5): 692-698.
4. Nakao A, Fujii T, Sugimoto H, et al. Is pancreaticogastrostomy safer than pancreaticojejunostomy? [J]. J Hepatobiliary Pancreat Surg, 2006; 13(3): 202-206.
5. Yoe CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy [J]. Ann Surg, 1995; 222(4): 580-592.
6. Ohwada S, Tanahashi Y, Ogawa T, et al. In situ vs ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with billroth Ⅰ-type reconstruction [J]. Arch Surg, 2002; 137(11): 1289-1293.
7. Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [J]. J Gastrointest Surg, 2004; 8(8): 951-959.
8. 李海民, 窦科峰, 宋振顺, 等. 套入式双层连续缝合加捆绑在胰肠吻合术中的应用 [J]. 中国普外基础与临床杂志, 2007; 14(4): 480.
9. 彭淑牖, 吴育连, 彭承宏, 等. 捆绑式胰肠吻合术(附28例报告) [J]. 中华外科杂志, 1997; 35(3): 158-159.
10. 张春秋, 王国华, 彭晓晖, 等. 捆绑式胰肠吻合术在预防胰十二指肠切除术后胰瘘发生中的临床应用 [J]. 中国普外基础与临床杂志, 2008; 15(8): 565-566.
11. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy [J]. Ann Surg, 1995; 221(6): 635-645.
12. Greene BS, Loubeau JM, Peoples JB, et al. Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures? [J]. Am J Surg, 1991; 161(1): 45-50.
13. 王志军, 吴阳, 彭启平, 等. 胰十二指肠切除术后发生胰瘘的危险因素 [J]. 中国普外基础与临床杂志, 2005; 12(4): 403-405.
14. Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial [J]. J Am Coll Surg, 2009; 208(5): 738-749.
15. 时开网, 杨坤兴, 倪绍忠, 等. 胰十二指肠切除59例临床分析 [J]. 江苏医药杂志, 2003; 29(1): 29-30.
16. Lemaire E, O’Toole D, Sauvanet A, et al. Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis [J]. Br J Surg, 2000; 87(4): 434-438.
17. Amano H, Takada T, Ammori BJ, et al. Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study [J]. Hepatogastroenterology, 1998; 45(24): 2382-2387.
18. Kurosaki I, Hatakeyama K, Kobayashi T, et al. Pancreaticogastrostomy: unreliable long-term pancreatic duct patency [J]. Hepatogastroenterology, 2003; 50(50): 545-549.
19. Staley CA, Lee JE, Cleary KR, et al. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head [J]. Am J Surg, 1996; 171(1): 118-125.
20. 叶春, 席鹏程, 胡先贵. 胰腺钩突部癌的临床特征和诊断治疗 [J]. 中华外科杂志, 2002; 40(10): 766-768.
21. Fischer CP, Bass B, Fahy B, et al. Transampullary pancreatic duct stenting decreases pancreatic fistula rate following left pancreatectomy [J]. Hepatogastroenterology, 2008; 55(81): 244-248.
22. Winter JM, Cameron JL, Campbell KA, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial [J]. J Gastrointest Surg, 2006; 10(9): 1280-1290.
23. Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial [J]. Ann Surg, 2007; 246(3): 425-435.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Inner Diameter of Pancreatic Duct Following Pancreaticoduodenectomy on Pancreatic Fistula

Abstract Full text Figures/Tables Video References Cited by

Format

Content