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Journal of Vascular and Interventional... Oct 2022Interventional radiology can be used to perform complex pancreatic duct (PD) interventions in cases in which PD abnormalities limit the feasibility of an endoscopic...
Interventional radiology can be used to perform complex pancreatic duct (PD) interventions in cases in which PD abnormalities limit the feasibility of an endoscopic approach. A multidisciplinary approach with gastroenterology using the rendezvous technique can improve procedural success. The establishment of through-and-through access to the PD via a combined percutaneous and endoscopic approach can be used when endoscopy alone fails. In this study, 3 cases are presented in which the rendezvous technique was successfully employed to access the PD for subsequent interventions.
Topics: Abdomen; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endoscopy, Gastrointestinal; Humans; Pancreatic Ducts
PubMed: 36182255
DOI: 10.1016/j.jvir.2022.06.021 -
Asian Journal of Surgery Sep 2023
Topics: Humans; Pancreaticojejunostomy; Pancreatic Ducts; Pancreatic Fistula; Stents; Pancreaticoduodenectomy; Postoperative Complications
PubMed: 37037747
DOI: 10.1016/j.asjsur.2023.03.145 -
Surgical Endoscopy Jul 2022To present a new pancreaticojejunostomy technique for laparoscopic pancreaticoduodenectomy (LPD) and to evaluate its safety and reliability.
BACKGROUND
To present a new pancreaticojejunostomy technique for laparoscopic pancreaticoduodenectomy (LPD) and to evaluate its safety and reliability.
METHODS
The data of 120 patients who underwent LPD at a single centre from October 2017 to October 2019 were retrospectively analysed. Of these patients, 71 received continuous suture pancreaticojejunostomy, and 49 received "8-character" suture pancreaticojejunostomy for LPD. We compared and analysed the operation time, anastomosis time, and incidence of postoperative complications between the patients in the two groups.
RESULTS
All operations were successfully performed, with no transfer to open surgery. The operation time and anastomosis time in the continuous suture group were lower than those in the "8-character" suture group (305.8 ± 60.7 min vs. 354.3 ± 69.1 min; 28.6 ± 6.3 min vs. 39.4 ± 11.9 min P < 0.001), and the postoperative hospital stay was also shorter (12.9 ± 3.8 days vs. 15.4 ± 5.8 days P < 0.05) in the continuous suture group. There was no significant difference in the pancreatic duct diameter or intraoperative blood loss between the two groups. There was also no significant difference in the incidence of a pancreatic fistula between the continuous suture group and the "8-character" suture group. The data of patients in the continuous suture group with pancreatic duct diameters < 3 mm and ≥ 3 mm were statistically analysed. There was no significant difference in the operation time, pancreaticojejunostomy time, postoperative hospital stay, or incidence of pancreatic fistula in the different pancreatic duct diameter groups.
CONCLUSIONS
Continuous suture of pancreaticojejunostomy in LPD is simple, safe, reliable, and rapid. This technique not only saves the anastomosis time but also suitable for pancreatic ducts < 3 mm.
Topics: Anastomosis, Surgical; Humans; Jejunum; Laparoscopy; Pancreatic Ducts; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Reproducibility of Results; Retrospective Studies; Suture Techniques; Sutures
PubMed: 34988736
DOI: 10.1007/s00464-021-08920-1 -
Journal of Gastroenterology and... May 2022
Review
Topics: Catheter Ablation; Cholangiopancreatography, Endoscopic Retrograde; Constriction, Pathologic; Humans; Pancreatic Ducts; Pancreatic Neoplasms; Radiofrequency Ablation
PubMed: 34761433
DOI: 10.1111/jgh.15724 -
BMC Gastroenterology Nov 2022Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD...
BACKGROUND
Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD diameter in predicting malignancy may be related to the lesion location. This study aimed to separately identify the thresholds of MPD for malignancy of IPMNs separately for the head-neck and body-tail.
MATERIALS AND METHODS
A total of 185 patients with pathologically confirmed IPMNs were included. Patient demographic information, clinical data, and pathological features were obtained from the medical records. Those IPMNs with high-grade dysplasia or with associated invasive carcinoma were considered as malignant tumor. Radiological data including lesion location, tumor size, diameter of the MPD, mural nodule, and IPMN types (main duct, MD; branch duct, BD; and mixed type, MT), were collected on computed tomography or magnetic resonance imaging. Serum carbohydrate antigen 19-9 levels, serum carcinoembryonic antigen levels, and the medical history of diabetes mellitus, chronic cholecystitis, and pancreatitis were also collected.
RESULTS
Malignant IPMNs were detected in 31.6% of 117 patients with lesions in the pancreatic head-neck and 20.9% of 67 patients with lesions in the pancreatic body-tail. In MPD-involved IPMNs, malignancy was observed in 54.1% of patients with lesions in the pancreatic head-neck and 30.8% of patients with lesions in the pancreatic body-tail (p < 0.05). The cutoff value of MPD diameter for malignancy was 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail in all type of IPMNs. In MPD-involved IPMNs, the threshold was 8.2 mm for lesion in pancreatic head-neck and 7.7 mm for lesions in the body-tail. Multivariate analysis confirmed that MPD diameter ≥ 6.5 mm (pancreatic head-neck) and MPD diameter ≥ 7.7 mm (pancreatic body-tail) were independent predictors of malignancy (p < 0.05). Similar results were observed in MPD-involved IPMNs using 8.2 mm as a threshold.
CONCLUSION
The thresholds of the dilated MPD may be associated with IPMNs locations. Thresholds of 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail were observed. For MPD-involved IPMNs alone, threshold for lesions in the head-neck was close to that in the body-tail.
Topics: Humans; Carcinoma, Pancreatic Ductal; Pancreatic Ducts; Pancreatic Neoplasms; Head; Tomography, X-Ray Computed
PubMed: 36402960
DOI: 10.1186/s12876-022-02577-3 -
Surgical Laparoscopy, Endoscopy &... Jun 2023The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic...
OBJECTIVE
The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic surgery.
MATERIALS AND METHODS
The data of 19 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and 2 patients who underwent laparoscopic central pancreatectomy were retrospectively analyzed.
RESULTS
All patients underwent pure laparoscopic surgery successfully with simplified duct-to-mucosa pancreaticojejunostomy. The operation time of LPD was 365.11±41.56 minutes, the time of pancreaticojejunostomy was 28.39±12.58 minutes, and postoperative hospitalization time was 14.16±6.88 days on average. Postoperative complications occurred in 3 patients of LPD, including 2 cases of class B postoperative pancreatic fistula and 1 case of gastroparesis followed by gastrointestinal anastomotic perforation. The operative time of laparoscopic central pancreatectomy was 191.00±12.73 minutes, the time of pancreaticojejunostomy 36.00±5.66 minutes, and the postoperative hospitalization time 12.5±0.71 days on average.
CONCLUSIONS
The described technique is a simple and safe reconstruction procedure and suitable for patients with nondilated pancreatic duct.
Topics: Humans; Pancreaticojejunostomy; Retrospective Studies; Pancreatic Neoplasms; Pancreatic Ducts; Pancreaticoduodenectomy; Pancreatic Fistula; Laparoscopy; Postoperative Complications
PubMed: 37010359
DOI: 10.1097/SLE.0000000000001084 -
Revista Espanola de Enfermedades... Dec 2022Disconnected pancreatic duct syndrome (DPCS) is due to disruption of the main pancreatic duct (PC) or its secondary branches, a complication present in 30-80% of acute...
Disconnected pancreatic duct syndrome (DPCS) is due to disruption of the main pancreatic duct (PC) or its secondary branches, a complication present in 30-80% of acute necrotizing pancreatitis. The secretion of pancreatic enzymes by isolated functioning pancreatic tissue can facilitate the recurrence of encapsulated necrotic collections, so its endoscopic management remains a controversial issue in daily practice. We present a case of disconnected pancreatic duct syndrome resolved after placement of a pancreatic stent.
Topics: Humans; Pancreatic Ducts; Pancreas; Pancreatitis, Acute Necrotizing; Endoscopy; Drainage; Syndrome; Stents; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 36281925
DOI: 10.17235/reed.2022.9261/2022 -
Surgery May 2022Thoracopancreatic fistulae are a rare complication of chronic pancreatitis. The aim of the present study is to evaluate potential risk factors for endoscopic treatment... (Review)
Review
BACKGROUND
Thoracopancreatic fistulae are a rare complication of chronic pancreatitis. The aim of the present study is to evaluate potential risk factors for endoscopic treatment failure and explore the safety of surgery when utilized either upfront or as a "bail-out" procedure after failed endoscopic treatment.
METHOD
A comprehensive literature search was conducted on the MedLine, Scopus, Embase, and Web of Knowledge databases for cases of thoracopancreatic fistulae. Data regarding patient demographics, fistula anatomy, and treatment interventions performed were extracted for further analysis.
RESULTS
The study pool consisted of 75 case reports and 19 case series published between the years 1972 and 2020. Duct disruption in the pancreatic body was most commonly encountered (41.1%), and a left pleural effusion was the most common manifestation (46%). Endoscopic treatment was attempted for 104 patients with an overall success rate of 42.3% (n = 44). Predictive factors for eventual success of endoscopic treatment were the ability of endoscopic retrograde cholangiopancreatography to diagnose the thoracopancreatic leak (odds ratio 9.76, 95% confidence interval 2.71-35.09, P < .001), the use of pancreatic duct stents (odds ratio 22.1, 95% confidence interval 7.92-61.61, P < .001), and the use of sphincterotomy (odds ratio 7.96, 95% confidence interval 2.1-30.1, P < .001). Conversely, the presence of pancreatic duct calculi was associated with endoscopic treatment failure (odds ratio 0.34, 95% confidence interval 0.12-0.94, P = .03). Pooled results suggest that surgical outcomes were comparable between the primary and salvage surgery groups.
CONCLUSION
A step-up approach from endoscopic management to salvage surgery may be effectively employed in cases of thoracopancreatic fistulae refractory to endoscopic treatment.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Fistula; Humans; Pancreas; Pancreatic Ducts; Pancreatitis, Chronic; Sphincterotomy, Endoscopic; Stents; Treatment Outcome
PubMed: 34742569
DOI: 10.1016/j.surg.2021.08.052 -
Gastrointestinal Endoscopy Nov 2020
Topics: Drainage; Endosonography; Humans; Pancreatic Ducts
PubMed: 33160488
DOI: 10.1016/j.gie.2020.05.053 -
Clinical Gastroenterology and... Jul 2021
Topics: Humans; Pancreatic Ducts; Stents
PubMed: 33249024
DOI: 10.1016/j.cgh.2020.08.056