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Wu S, Li J, Zhang B, Wang C, Abuduwaili A, Zhang J, Zhang S, Geng C, Xu X. Comparison of pancreaticojejunostomy under the theory of mucosal priority healing with duct-to-mucosa anastomosis and invagination pancreaticojejunostomy after pancreaticoduodenectomy: A single-centre case-control study. Sci Prog 2025; 108:368504251345016. [PMID: 40397114 PMCID: PMC12099170 DOI: 10.1177/00368504251345016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
ObjectiveThe technological aspects of pancreaticoduodenectomy have progressed greatly, but the risk of postoperative complications, especially postoperative pancreatic fistula (POPF), postpancreatectomy haemorrhage (PPH) and mortality, is high. Therefore, we aimed to explore the safety and feasibility of pancreaticojejunostomy (PJ) under the mucosal priority healing theory through a case-control study.MethodsWe have described in detail PJ under the theory of preferential mucosal healing (PM-PJ). In a cohort of patients based on predictors of pancreatic fistula, comparisons were made according to the type of PJ: PM-PJ (n = 312); duct-to-mucosa PJ (DtoM-PJ, n = 116); and invagination PJ (IPJ, n = 109). The primary endpoint was the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). The secondary endpoints were PPH, secondary surgery, death 90 days after surgery, and other postoperative complications.ResultsThe incidence rate of CR-POPF in the PM-PJ group was not significantly different from that in the DtoM-PJ group (13.78% vs. 6.9%; p = 0.051) or the IPJ group (13.78% vs. 11.9%; p = 0.623). However, the PM-PJ group exhibited significant reductions in serious postoperative complications (7.4% versus 30.2%; p < 0.001), PPH (1.3% versus 8.4%; p < 0.001), reoperation rates (0.6% versus 9.3%; p < 0.001) and 90-day postoperative mortality rates (0.32% versus 2.6%; p = 0.023). Multivariate LASSO regression analysis revealed that BMI, hypertension, gland texture, duct size, vascular resection and pathological type were independent risk factors for CR-POPF.ConclusionsPM-PJ is safe and reliable. During surgery, there are fewer suture needles and less trauma, which may reduce the incidence of serious complications such as postoperative bleeding and mortality.
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Affiliation(s)
- Shixing Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Jiangang Li
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Bolin Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Cheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Atigu Abuduwaili
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Junxiang Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Shouchao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Cheng Geng
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Xinjian Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
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Kato T, Watanabe Y, Baba Y, Oshima Y, Takase K, Watanabe Y, Okada K, Aikawa M, Okamoto K, Koyama I. Preoperative risk-stratified analysis: External versus internal pancreatic stents in pancreatoduodenectomy. Surgery 2025; 178:108845. [PMID: 39384476 DOI: 10.1016/j.surg.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/08/2024] [Accepted: 09/09/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Several risk-stratified studies have compared the outcomes of external and internal pancreatic stents in pancreatoduodenectomy (PD), but no resolute standard for a fistula-mitigation strategy exists. The study investigated the efficacy of these stents in a preoperative risk-stratified setting. METHODS Data from 285 patients who underwent PD with pancreaticojejunostomy using an external or internal stent from 2015 to 2023 were analyzed. The preoperative pancreatic fistula score (preFRS) was used to classify patients into low-risk (preFRS: 0-5) and high-risk (preFRS: 6-8) groups. RESULTS PreFRS accurately predicted the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) as 0% and >40% in patients with preFRS ≤1 and ≥7, respectively. Although no significant difference was observed in postoperative outcomes in low-risk patients, the external stent significantly reduced CR-POPF (21% vs 44%, P = .024) and postpancreatectomy hemorrhage (PPH, 0% vs 19%, P = .02) in high-risk patients, leading to the superiority of the external stent in the entire cohort in terms of CR-POPF (12% vs 24%, P = .033) and PPH (1% vs 11%, P = .013). There were no significant differences in stent-related complications or pancreatic dysfunction. External stent malfunction occurred in 14% and significantly affected CR-POPF development in both low- (20% vs 0%, P < .01) and high-risk groups (60% vs 14%, P = .021). CONCLUSION The external pancreatic stent showed a more beneficial effect on CR-POPF and PPH, especially in high-risk patients, without increasing other complications. Risk-stratified strategy and improving stent management might enhance postoperative outcomes.
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Affiliation(s)
- Tomotaka Kato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuhei Oshima
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kenichiro Takase
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yukihiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Katsuya Okada
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masayasu Aikawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Symeonidis D, Zacharoulis D, Tzovaras G, Kissa L, Samara AA, Petsa E, Tepetes K. Stent A pancreaticojejunostomy after pancreatoduodenectomy: Is it always necessary? World J Methodol 2024; 14:90164. [PMID: 39310242 PMCID: PMC11230077 DOI: 10.5662/wjm.v14.i3.90164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/19/2024] [Accepted: 04/07/2024] [Indexed: 06/25/2024] Open
Abstract
The establishment of a postoperative pancreatic fistula (POPF) is considered the most common and, concomitantly, the most serious complication associated with pancreaticoduodenectomy (PD). The search for either technical modifications of the operative technique or pharmaceutical interventions that could possibly aid in decreasing the incidence of this often-devastating complication appears justified. The stenting of the pancreatic duct, with the use of either internal or external stents, has been evaluated in this direction. In theory, it is an approach that could eliminate many pathophysiological factors responsible for the occurrence of a POPF. The purpose of the present study was to review the current data regarding the role of pancreatic duct stenting on the incidence of POPF, after PD, by using PubMed and Reference Citation Analysis. In general, previous studies seem to highlight the superiority of external stents over their internal counterparts in regard to the incidence of POPF; this is at the cost, however, of increased morbidity associated mainly with the stent removal. Certainly, the use of an internal stent is a less invasive approach with acceptable results and is definitely deprived of the drawbacks arising through the complete diversion of pancreatic juice from the gastrointestinal tract. Bearing in mind the scarcity of high-quality data on the subject, an approach of reserving stent placement for the high-risk for POPF patients and individualizing the selection between the use of an internal or an external stent according to the distinct characteristics of each individual case scenario appears appropriate.
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Affiliation(s)
| | | | - Georgios Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Labrini Kissa
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Eleana Petsa
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Konstantinos Tepetes
- Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
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Gaujoux S, Regimbeau JM, Piessen G, Truant S, Foissac F, Barbier L, Buc E, Adham M, Fuks D, Deguelte S, Muscari F, Sulpice L, Vaillant JC, Schwarz L, Sa Cunha A, Muzzolini M, Dousset B, Sauvanet A. Somatostatin Versus Octreotide for Prevention of Postoperative Pancreatic Fistula: The PREFIPS Randomized Clinical Trial: A FRENCH 007-ACHBT Study. Ann Surg 2024; 280:179-187. [PMID: 38662619 DOI: 10.1097/sla.0000000000006313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Pharmacological prevention of postoperative pancreatic fistula (POPF) after pancreatectomy is open to debate. The present study compares clinically significant POPF rates in patients randomized between somatostatin versus octreotide as prophylactic treatment. METHODS Multicentric randomized controlled open study in patient's candidate for pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) comparing somatostatin continuous intravenous infusion for 7 days versus octreotid 100 μg, every 8 hours subcutaneous injection for 7 days, stratified by procedure (PD vs DP) and size of the main pancreatic duct (>4 mm) on grade B/C POPF rates at 90 days based on an intention-to-treat analysis. RESULTS Of 763 eligible patients, 651 were randomized: 327 in the octreotide arm and 324 in the somatostatin arm, with comparable the stratification criteria - type of surgery and main pancreatic duct dilatation. Most patients had PD (n=480; 73.8%), on soft/normal pancreas (n=367; 63.2%) with a nondilated main pancreatic duct (n=472; 72.5%), most often for pancreatic adenocarcinoma (n=311; 47.8%). Almost all patients had abdominal drainage (n=621; 96.1%) and 121 (19.5%) left the hospital with the drain in place (median length of stay=16 days). A total of 153 patients (23.5%) developed a grade B/C POPF with no difference between both groups: 24.1%: somatostatin arm and 22.9%: octreotide arm (χ 2 test, P =0.73, ITT analysis). Absence of statistically significant difference persisted after adjustment for stratification variables and in per-protocol analysis. CONCLUSION Continuous intravenous somatostatin is not statistically different from subcutaneous octreotide in the prevention of grade B/C POPF after pancreatectomy. FINDINGS In the PREFIPS Randomized Clinical Trial including 651 patients, a total of 153 patients (23.5%) developed a grade B/C POPF with no significant difference between both groups: 24.1%: somatostatin arm and 22.9%: octreotide arm (χ 2 test, P =0.73, ITT analysis). Absence of statistically significant difference persisted after adjustment for stratification variables and in per-protocol analysis.
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Affiliation(s)
- Sébastien Gaujoux
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Jean-Marc Regimbeau
- Department of Oncology and Digestive Surgery, CHU Amiens-Picardie, Amiens, France
- University of Picardie Jules-Vernes, Amiens, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Stéphanie Truant
- University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille, France
| | - Frantz Foissac
- Clinical Research Unit Necker Cochin Hospital, APHP, Paris, France
| | - Louise Barbier
- Department of Digestive Surgery and Liver Transplantation, CHU Tours Trousseau, Tours, France
- University of Tours, Tours, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Clermont-Ferrand Faculty of Medicine, Clermont-Ferrand, France
| | - Mustapha Adham
- Digestive Surgery Unit, Edouard Herriot Hospital, Lyon, France
- Hospices Civils of Lyon University, Lyon, France
| | - David Fuks
- Department of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
- University of Paris, Paris, France
| | - Sophie Deguelte
- Digestive Surgery Department, Reims University Hospital, Robert Debré Hospital, Reims, France
- Reims University Hospital, Robert Debré Hospital, Reims, France
| | - Fabrice Muscari
- Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
- Toulouse University, Toulouse, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery Hospital Rennes, Rennes, France
- Rennes University, Rennes, France
| | - Jean-Christophe Vaillant
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Charles Nicolle Hospital, Rouen, France
- Rouen University, Rouen, France
| | - Antonio Sa Cunha
- Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
- Paris-Saclay University, Saclay, France
| | - Milena Muzzolini
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Bertrand Dousset
- Department of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
- University of Paris, Paris, France
| | - Alain Sauvanet
- Department of Hepatobiliary Surgery, Beaujon Hospital, Clichy, France
- University Paris Cité, Paris, France
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Zhou B, Gao Z, Tian Y, Yan S. A modified Blumgart method using a homemade crochet needle facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy: a retrospective cohort study. BMC Surg 2024; 24:22. [PMID: 38218837 PMCID: PMC10787960 DOI: 10.1186/s12893-023-02308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Among the safest procedures for anastomosis in pancreaticoduodenectomy, Blumgart pancreaticojejunostomy is associated with low rates of postoperative pancreatic fistula (POPF) and postoperative complications. However, this technique is difficult to perform during laparoscopic pancreaticoduodenectomy (LPD). This study presents a modified Blumgart method using a homemade crochet needle to facilitate laparoscopic pancreaticojejunostomy and evaluates its safety and reliability. METHODS From February 2019 to October 2022, 96 LPD surgeries with the new technique were performed by the same surgeons in the Second Affiliated Hospital of Zhejiang University School of Medicine. The operative details (operative time, pancreaticojejunostomy time, POPF rate, postoperative complication rate, mortality rate) were analyzed along with clinical and pathological indicators (pancreatic duct diameter, pancreatic texture, and histopathological findings). RESULTS There were 54 men and 42 women with a mean age of 63.38 ± 10.41 years. The intraoperative bleeding volume, operative time and postoperative length of hospital stay were 198.43 ± 132.97 mL, 445.30 ± 87.05 min and 13.68 ± 4.02 days, respectively. The operation time of pancreaticojejunostomy was 66.28 ± 10.17 min. Clinically relevant POPFs (grades B and C) occurred in 14.6% of patients. Only one patient had postoperative abdominal hemorrhage and was cured after reoperation. There were no operative or in-hospital deaths. With our proposed modification, the pancreatic duct and jejunal orifice are aligned correctly during duct-to-mucosa (DTM) after the application of external traction through the homemade crochet needle. The space between the posterior wall of pancreatic remnant and jejunal loop can be exposed by adjusting the tension of the external threads, which can facilitate DTM. CONCLUSIONS A modified Blumgart method using a homemade crochet needle could be technically feasible and safe during LPD. A randomized control trial is needed to confirm these findings.
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Affiliation(s)
- Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhenzhen Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yang Tian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Xiang C, Chen Y, Liu X, Zheng Z, Zhang H, Tan C. Prevention and Treatment of Grade C Postoperative Pancreatic Fistula. J Clin Med 2022; 11:7516. [PMID: 36556131 PMCID: PMC9784648 DOI: 10.3390/jcm11247516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Postoperative pancreatic fistula (POPF) is a troublesome complication after pancreatic surgeries, and grade C POPF is the most serious situation among pancreatic fistulas. At present, the incidence of grade C POPF varies from less than 1% to greater than 9%, with an extremely high postoperative mortality rate of 25.7%. The patients with grade C POPF finally undergo surgery with a poor prognosis after various failed conservative treatments. Although various surgical and perioperative attempts have been made to reduce the incidence of grade C POPF, the rates of this costly complication have not been significantly diminished. Hearteningly, several related studies have found that intra-abdominal infection from intestinal flora could promote the development of grade C POPF, which would help physicians to better prevent this complication. In this review, we briefly introduced the definition and relevant risk factors for grade C POPF. Moreover, this review discusses the two main pathways, direct intestinal juice spillover and bacterial translocation, by which intestinal microbes enter the abdominal cavity. Based on the abovementioned theory, we summarize the operation techniques and perioperative management of grade C POPF and discuss novel methods and surgical treatments to reverse this dilemma.
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Affiliation(s)
| | | | | | | | | | - Chunlu Tan
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Sulieman I, Elaffandi A, Elmoghazy W, Khalaf H. USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience. Surg Innov 2022:15533506221123355. [PMID: 36148813 DOI: 10.1177/15533506221123355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Plastic stents have been used to avoid postoperative pancreatic fistula (POPF) following Whipple's Pancreaticoduodenectomy (WPD), but they may cause some stent-related complications. Biodegradable stents have been recently introduced and might be a safe alternative. Here we present our initial experience with their use. Methods. Between March 1, 2020, and September 30, 2020, ten (10) consecutive patients underwent WPD. They all had conventional two-layer pancreaticojejunostomy with the placement of an internal biodegradable stent. They were assessed for technical feasibility, pancreatic leak, and stent-related complications. Results. The use of biodegradable stents was technically feasible in all patients, despite some difficulties in insertion due to stent stiffness and design. After a median follow-up period of 124 days, none of the patients suffered POPF. One patient had a biochemical pancreatic leak with no clinical significance. The median hospital stay was 7 days, and there were no stent-related complications. Conclusion. Biodegradable stents are technically feasible and safe in WPD with good short-term outcomes. They might provide a better alternative to plastic stents and their potential complications. Larger long-term studies are needed to validate efficacy and safety. Few modifications of the stent's design might be needed to facilitate use in open surgery.
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Affiliation(s)
- Ibnouf Sulieman
- Department of Surgery, Division of Organ Transplant, 36977Hamad General Hospital, Doha, Qatar
| | - Ahmed Elaffandi
- Department of Surgery, Division of Organ Transplant, 36977Hamad General Hospital, Doha, Qatar.,Department of Surgical Oncology, National Cancer Institute, 36977Cairo University, Egypt
| | - Walid Elmoghazy
- Department of Surgery, Division of Organ Transplant, 36977Hamad General Hospital, Doha, Qatar.,Department of Surgery, 36977Sohag University, Sohag, Egypt
| | - Hatem Khalaf
- Department of Surgery, Division of Organ Transplant, 36977Hamad General Hospital, Doha, Qatar.,Department of Surgery, College of Medicine, 36977Qatar University, Qatar
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He CC, Wu MD, Wang CH. Impact of internal and external drainage of the pancreatic duct on pancreatic fistula after pancreaticoduodenectomy: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2021; 29:1341-1348. [DOI: 10.11569/wcjd.v29.i23.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the domestic and foreign research on the impact of internal and external drainage of the pancreatic duct on pancreatic fistula after pancreaticoduodenectomy (PD), we conducted a meta-analysis to provide doctors with evidence on its applications in clinical work.
AIM To systematically evaluate the effect of internal and external drainage of the pancreatic duct on pancreatic fistula after PD.
METHODS PubMed, Embase, Cochrane, CNKI, CBM, Wanfang, and VIP were searched for randomized controlled and retrospective studies on internal and external drainage after PD resection from 2016 to 2021. According to the inclusion and exclusion criteria, the literature was selected, the data were extracted, and the literature quality was evaluated. Rev Man 5.3 software was used for meta-analysis.
RESULTS A total of four retrospective studies with 1213 patients were included. The results of meta-analysis showed that there was no significant difference in the improvement of clinically relevant pancreatic fistula after PD between internal and external drainage [odds ratio (OR) = 1.42, 95% confidence interval (CI): 0.84-2.40, P = 0.19]. Sensitivity analysis suggested that there was no heterogeneity among the studies (P = 0.33, I2 = 8.7%). The difference was statistically significant after pooling the results using the fixed-effects model (OR = 1.83, 95%CI: 1.12-2.99, P = 0.02). External drainage can reduce the incidence of postoperative clinically related pancreatic fistula. Subgroup analysis showed that there was no difference in the improvement of grade B (OR = 0.95, 95%CI: 0.64-1.40, P = 0.78] or grade C pancreatic fistula (OR = 1.58, 95%CI: 0.81- 3.09, P = 0.18).
CONCLUSION External drainage of the supporting duct can reduce the incidence of clinically relevant pancreatic fistula after surgery, but there is no difference in the improvement of grades B and C pancreatic fistula. Further research is required to verify our findings.
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Affiliation(s)
- Chen-Chen He
- China Medical University, Shenyang 110000, Liaoning Province, China
| | - Ming-Dong Wu
- China Medical University, Shenyang 110000, Liaoning Province, China
| | - Chun-Hui Wang
- Department of Hepatological Surgery, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
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