Relative displacement of anastomotic site of pancreato-jejunostomy in pancreatico-duodenectomy: a novel surgical reconstructive techniqueReportar como inadecuado




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Journal of Medical Case Reports

, 7:209

First Online: 14 August 2013Received: 23 September 2012Accepted: 02 May 2013DOI: 10.1186-1752-1947-7-209

Cite this article as: Usuba, T., Iino, T. & Hanyu, N. J Med Case Reports 2013 7: 209. doi:10.1186-1752-1947-7-209

Abstract

IntroductionIntra-abdominal hemorrhage following pancreatic fistula is a fatal complication after pancreatico-duodenectomy. Intra-abdominal hemorrhage has reportedly decreased with the use of fibrin glue or polyglycolic acid felt and wrapping of the skeletonized vessels by omentum or falciform ligament. However, there are no extremely effective methods for the prevention of hemorrhage. Here, we report our novel and simple method for the prevention of intra-abdominal hemorrhage due to pancreatic fistula.

MethodsThe anastomotic site of the pancreato-jejunostomy in pancreatico-duodenectomy is displaced from the superior to inferior side of the transverse mesocolon through a small window created on the left side of the middle colic artery of the transverse mesocolon. This procedure is expected to prevent exposure of the skeletonized vessels to activated pancreatic juice from a pancreatic fistula after lymph node dissection, decreasing the incidence of hemorrhage. Two drains are placed on the superior and inferior sides of the transverse mesocolon. We performed this procedure in seven patients and compared the amylase level in the drainage fluid from the superior and inferior sides.

ResultsThere was no difference in the fluid amylase level from the drains between the superior and inferior sides, because a pancreatic fistula was not present in all our patients. Therefore, we could not evaluate the efficacy of this method in the current study.

ConclusionsOur procedure is theoretically expected to prevent intra-abdominal hemorrhage and will be an option in pancreatico-duodenectomy, especially for patients with a soft pancreas. However, it is necessary to evaluate the performance and results of this procedure in many more patients.

KeywordsDisplacement of anastomosis pancreatic fistula pancreatico-duodenectomy Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-7-209 contains supplementary material, which is available to authorized users.

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Autor: Teruyuki Usuba - Toshio Iino - Nobuyoshi Hanyu

Fuente: https://link.springer.com/







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