Pancreaticojejunostomy - Risk Anastomosis after Cephalic Pancreaticoduodenectomy

Introduction: The authors bring to attention pancreaticojejunalanastomosis (PJA) performed after cephalic pancreaticoduodenectomy(CPD). This type of anastomosis is renowned forits high risk of complications. Among these complications, pancreatic fistula (PF) is distinguishable due to a significantfrequency, averaging 10%. It is perhaps the most unsafe type of anastomosis in digestive surgery, due to its pancreatic partnership. Performing a sealed APJ can be considered a greatachievement: a digestive lumen is set in contact with a brittleparenchymal structure, centred by a delicate excretory channel, difficult to anastomose in itself. Material and methods: We studied two distinct groups ofpatients undergoing CPD. A first group - 58 cases operatedon between 1967 and 1983, and the second one - 70 casesoperated on between 1984 - 2013. In all cases we performedPJA; by in-continuity loop technique in the first group, andwith separate loop in the second group. In the second groupwe used a variant own technique that does not allow anastomotic loss of pancreatic fluid. Thus, a decline in theincidence of PF from 20% to 8% was obtained, the final percentage corresponding to group two. Of the 8% of patientswith PF losses were recorded strictly at pancreatic level, withno bile or food contamination. Stenting was recorded forbiliary- and pancreaticojejunal anastomoses in group two. Discussions: The percentage of PF after CPD did not show anynotable revival when comparing the 1980s period to thepresent. Also, mortality due to FP is approaching 40%, adaunting figure. The multitude of technical options forrestoring bowel movement after CPD, over 80 procedures, further confirms the lack of safety and trust in relation to PJA.The authors bring forward several surgical gestures addressing PJA, gestures capable of providing an 8% frequency of PF,percentage which we consider to be reasonable. Conclusions: The authors consider PJA stenting mandatory.Placing an isolated PJA on the short branch of the "Y", separate from the biliary and food flow, prevents the formation of acomplex fistula. The proposed technique does not require a"duct - to - mucosa" type or "telescoping" type pancreaticojejunalanastomosis.

• Timeviewed: 1508 times
• Download

• Rezumat
• Abstract