Experience of pancreaticodigestive anastomosis performing in pancreaticoduodenectomy

O.B. Kutovyi; K.O.  Denysova

doi:10.26641/2307-0404.2022.2.260259

Authors

O.B. Kutovyi Dnipro State Medical University, V. Vernadskyi str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0003-2744-4595
K.O. Denysova Dnipro State Medical University, V. Vernadskyi str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0003-3634-2048

DOI:

https://doi.org/10.26641/2307-0404.2022.2.260259

Keywords:

pancreaticogastro, pancreaticogastrostomy, pancreatojejunostomy

Abstract

The aim of the study was to analyze the short-term and long-term results of pancreaticoduodenectomy (PD) on condition of performing different types of pancreaticodigestive anastomoses. The results of 108 PD of the period from 2008 to 2021 performed in the Department of Surgery N 2 on the basis of the Dnipro Regional Hospital named after І. Mechnikov were analyzed. Pancreatojejunostomy (PJ) was formed in 88 (81.5%) cases, pancreaticogastrostomy (PG) ‒ in 20 (18.5%). Depending on the transverse size of pancreatic isthmus and body, diameter of the pancreatic duct the method of PJ was chosen: telescope-type PJ «end-to-end» (n=26), Wirsung-jejunostomy (n=28), original method (n=34). In the PJ group the dense parenchyma of the pancreas was in 51 (58.0%) cases, soft parenchyma ‒ in 37 (42.0%), and in the PG group the dense gland was observed in 12 (60%) cases, soft ‒ in 8 (40%) patients (p>0,05). The number of the early postoperative complications was 43 (39,8±4,7%), among them there were (15,7±3,5%) patients with severe complications who required additional interventions. Mortality was 6.5±2.4%. The best results for the early postoperative complications were obtained in the groups of PG and original PJ. There were statistically significant differences in the total number of cases of the early postoperative complications between the groups of PG (20.0±8.9%) and telescope-type PJ (50.0±9.8%, p=0.037) and Wirsung-jejunostomy (50.0±9.4%, p=0.034), as well as while comparing the total number of patients with complications in the groups of PG and PJ (44.3±5.3%, p=0.045). There were not any statistically significant differences among the late postoperative complications (p>0.05).

References

Antomonov MYu. [Mathematical processing and analysis of biomedical data]. 2-e izd. Kyiv: Medinform. 2018. p. 579. Russian.

Galperin EI, Semenenko IA. [Fibrosis of pancreas in chronic pancreatitis]. Pirogov Russian Journal of Surgery. 2015;12:96-102. Russian. doi: https://doi.org/10.17116/hirurgia20151296-102

Коpchak VМ, Kopchak КV, Khomyak ІV, et al. [Prophylaxis of complications in patients after pancreaticoduodenal resection]. Clinical Surgery 2014;5:29-31. Ukrainian. Available from: http://nbuv.gov.ua/UJRN/KlKh_2014_5_10

Kutovyi OB, Denysova KO, inventors. [Method of forming pancreatojejunoanastomosis]. Ukraine patent 139485. Ukrainian.

Kutovyi OB, Denysova KO, Balyk DV, inventors. [The method of pancreatojejunostomy]. Ukraine patent 132705. Ukrainian.

Kutovyi OB, Denysova KO, Balyk DV, Marte-mianov VV, inventors. [The method pancreatojejunostomy bleedings diagnostics]. Ukraine patent 133883. Ukrainian

Fedorenko ZP, Michailovich YuY, Goulak LO, et al. [Cancer in Ukraine, 2019-2020 Incidence, mortality, prevalence and other relevant statistics]. Kyiv: Bulletin of the National Cancer Registry of Ukraine; 2021;22. Ukrainian.

De la Plaza Llamas R, Ramia JM. Postoperative complications in gastrointestinal surgery: A "hidden" basic quality indicator. World J Gastroenterol. 2019;25(23):2833-38. doi: https://doi.org/10.3748/wjg.v25.i23.2833

Dusch N, Lietzmann A, Barthels F, Niedergeth-mann M, et al. International Study Group of pancreatic Surgery definitions for postpancreatectomy complications: applicability at a HIGH-Volume center. Scand J Surg. 2017 Sep;106(3):216-22. doi: https://doi.org/10.1177/1457496916680944

Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55(9-10):1158-60. doi: https://doi.org/10.1080/0284186X.2016.1197419

Han Qin, Lin Luo, Zexin Zhu, Jiwei Huang. Pan-creaticogastrostomy has advantages over pancrea-ticojejunostomy on pancreatic fistula after pancreatico-duodenectomy. A meta-analysis of randomized controlled trials. International Journal of Surgery. 2016;36A:18-24. doi: https://doi.org/10.1016/j.ijsu.2016.10.020

Lennart B. van Rijssen, Maurice J, et al. Variation in hospital mortality after pancreatoduodenectomy is rela¬ted to failure to rescue rather than major complications: a nationwide audit. HPB. 2018:20(8):759-67, doi: https://doi.org/10.1016/j.hpb.2018.02.640

Lyu Y, Li T, Cheng Y, Wang B, Chen L, Zhao S. Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-ana¬lysis of RCTs Applying the ISGPS (2016) Criteria. Surg Laparosc Endosc. Percutan. Tech. 2018;28(3):139-46. doi: https://doi.org/10.1097/SLE.0000000000000530

Niesen W, Hank T, Büchler M, Strobel O. Local radicality and survival outcome of pancreatic cancer surgery. Ann Gastroenterol Surg. 2019 Jul 1;3(5):464-75. doi: https://doi.org/10.1002/ags3.12273

Olakowski M, Grudzińska E, Mrowiec S. Pan-creaticojejunostomy-a review of modern techniques. Langenbecks Arch Surg. 2020;405:13-22. doi: https://doi.org/10.1007/s00423-020-01855-6

Schorn S, Demir IE, Vogel T, et al. Mortality and postoperative complications after different types of surgi-cal reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysis. Langenbecks Arch Surg. 2019(404):141-57. doi: https://doi.org/10.1007/s00423-019-01762-5