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The thickness of pancreatic transection line as a risk factor for postoperative pancreatic fistula after distal pancreatectomy using the stapler
S114
Abstracts / Pancreatology 14 (2014) S1eS129
Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a pylorus-preserving pancreatoduodenectomy. Between 1998 and 2008 retrocolic duodeno/gastrojejunostomies were applied in 151 cases. Since 2008 the antecolic duodeno/gastrojejunostomy has been used in 123 cases for reconstruction completed with a Braun anastomosis between the afferent and efferent jejunal limb about 25 cm off the duodeno/gastrojejunostomy. Results: The differences were statistically not significant, regarding the postoperative hospitalization time, reoperation rate and operative mortality. Similarly the pre- and intraoperative data were statistically identical. However the frequency of DGE was significantly lower (2%) after antecolic recostruction, compared to that of the retrocolic group (10,6%, p: 0,040). Conclusion: It can be concluded that during pancreatoduodenectomy the antecolic reconstruction with a Braun anastomosis is associated with an especially low occurrence of DGE. The presumed explanations are e besides other possible factors e the “straight” duodeno/gastrojejunostomy without angulation and the prevention of reflux of bile and pancreatic juice into the stomach.
F-093. Laparoscopic pancreatic resections Kostiantyn Kopchak, Volodymyr Kopchak, Igor Khomiak, Oleksandr Duvalko, Liudmila Pererva, Serhii Andronik, Andriy Khomiak
Background: Stapler devices are commonly used as the technique of pancreas transection. But it is not known how much the thickness of pancreatic transection line devided by the stapler will be allowed to prevent pancretic fistula(PF) after distal pancreatectomy(DP). Aims: The aim of study was to determine risk factors of clinical PF after DP using the stapler. Patients & methods: Twenty three patients who underwent DP between April 2006 and February 2014 were enrolled in this study. The relationship between the incidence of PF and several clinical factors (operative factors and patients background) was retrospectively analyzed. As the technique of pancreas transection, we have chosen the tri-stapler technique of all patients, regardless open or laparoscopic DP. We have defined the stapled transection line 20mm proximal from the pancreas tumor, and measured the thickness of pancreas parenchyma. Results: GradeA PF occurred in 16patients(69.6%). Clinically relevant, GradeB PF occurred in 7patients(30.4%). There is no patient in GradeC PF and no patient died by postoperative complication. Compression thickness of pancreatic stump divided by a stapler was a significant risk factor for PF on univariate analysis: GradeA group 10.2mm, GradeB group 17.6mm (mean thickness). By drawing receiver operating characteristic (ROC) curve, a pancreas thicker than 16.5mm was suggested to be the adequate cut off for predicting PF after DP using the tri-stapler. (AUC: area under the curve¼ 0.937) Conclusion: The tri-stapler closure technique seems to be an adequate transection method for patients with a pancreatic thickness less than 16.5mm to prevent occurring PF after DP.
National institute of surgery and transplantology, department of pancreatic surgery, Ukraine Background: Implementation of laparoscopic techniques could bring potential advantages in pancreatic surgery Aims: To increase the results of pancreatic resections by implementation of laparoscopic techniques. Patients & methods: In our clinic 18 laparoscopic pancreatic resections were performed in the period 2009-2013 years: 8 distal pancreatectomies, 5 enucleations and 1 central resection in patients with benign tumors of the pancreas; in 2013 we performed 4 lapariscopic pancreaticoduodenectomies in 2 patients with distal cholangiocarcinoma and 2 patients with adenocarcinoma of papilla of Vater. The mean age was 27 ± 6.4 years. There were 15 (88,2%) female and 3 (11,8%) male patients. Results: The results were compared with open surgery operations. Mean duration of the laparoscopic distal pancreatectomy was 266,7 ± 87,3 minutes, mean blood loss - 293,8±174,6 ml, postoperative in-hospital stay -10,1±3,1 days. We found no significant difference in the levels of postoperative complications. There was no significant difference in the level of intraoperative blood loss and duration of surgery, which compared with distal resections. Length of postoperative hospital stay was significantly lower when performing laparoscopic surgery. Level of intraoperative blood loss and duration of surgery was significantly lower in a group of laparoscopic enucleations. Mean duration of the laparoscopic enucleations was 84±27,9 minutes, mean blood loss e minimal in all cases, postoperative inhospital stay -6±1,9 days Conclusion: Pancreatic resections from laparoscopic approach offer several advantages, but require the development of precise indications for surgery and optimal technique for its implementation. Training in laparoscopic pancreatic surgery is necessary for wide implementation of the technique.
F-094.
F-095. Pancreaticoduodenectomy for pancreatic and periampullary lesions in the young Yi-Ming Shyr, Shin-E. Wang Taipei Veterans General Hospital, Taiwan Background: PD remains a formidable challenge to many pancreatic surgeons. There is no literature report regarding PD in the young. Aims: The purpose of this study was to clarify surgical outcomes and to assess the biological behavior of periampullary malignancy after pancreaticoduodenectomy (PD) in the young Patients & methods: Data on patients undergoing PD were retrieved for study between January, 1997, and December, 2010. Demographics, disease patterns, clinical presentations, operative findings, surgical risks, tumor pathologic characteristics, and survival outcomes were evaluated in the young patients less than 60 years old and compared with those in the older population. Results: There were 585 patients in our study. Of there, 172 were patients 60 years or younger. Higher proportions of female patients were found in the young age group compared to old in regards to sex distribution. Young group had more benign tumor compared to the old, ex. neuroendocrine tumor. The surgical mortality rates are significant less in the Young group. However, there was no significant difference in surgical morbidity and pancreatic leakage. As for the initial presentations, young group patients are often asymptomatic (4.7%) when compared to the old (1.5%, P¼0.026) but less jaundice and GI upset (P¼0.004, P¼0.012). Conclusion: PD in the young did not carry more surgical morbidity or pancreatic leakage, but had less surgical mortality, as compared to the old. Young group patients after PD had better 5 year survival in periampullary malignancy and pancreatic head adenocarcinoma
The thickness of pancreatic transection line as a risk factor for postoperative pancreatic fistula after distal pancreatectomy using the stapler Akira Muraki a, Satoshi Mizutani a, Takayuki Aimoto b, Seiji Yamagishi a, Ryousuke Nakata a, Arichika Hoshino a, Eiji Uchida c a Institute of Gastroenterology, Nippon Medical School Musashi-kosugi Hospital, Kawasaki, Japan b Kobayashi Hospital, Tokyo, Japan c Department of Surgery, Nippon Medical School, Tokyo, Japan
F-096. The first experience of the laparoscopic drainage operations for treatment of the patients with chronic pancreatitis Andrianov Alexey, Igor Khatkov, Victor Tsvirkun, Roman Izrailov, Ruslan Alikhanov Moscow Clinical Scientific Centre, Russia
Abstracts / Pancreatology 14 (2014) S1eS129
Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a pylorus-preserving pancreatoduodenectomy. Between 1998 and 2008 retrocolic duodeno/gastrojejunostomies were applied in 151 cases. Since 2008 the antecolic duodeno/gastrojejunostomy has been used in 123 cases for reconstruction completed with a Braun anastomosis between the afferent and efferent jejunal limb about 25 cm off the duodeno/gastrojejunostomy. Results: The differences were statistically not significant, regarding the postoperative hospitalization time, reoperation rate and operative mortality. Similarly the pre- and intraoperative data were statistically identical. However the frequency of DGE was significantly lower (2%) after antecolic recostruction, compared to that of the retrocolic group (10,6%, p: 0,040). Conclusion: It can be concluded that during pancreatoduodenectomy the antecolic reconstruction with a Braun anastomosis is associated with an especially low occurrence of DGE. The presumed explanations are e besides other possible factors e the “straight” duodeno/gastrojejunostomy without angulation and the prevention of reflux of bile and pancreatic juice into the stomach.
F-093. Laparoscopic pancreatic resections Kostiantyn Kopchak, Volodymyr Kopchak, Igor Khomiak, Oleksandr Duvalko, Liudmila Pererva, Serhii Andronik, Andriy Khomiak
Background: Stapler devices are commonly used as the technique of pancreas transection. But it is not known how much the thickness of pancreatic transection line devided by the stapler will be allowed to prevent pancretic fistula(PF) after distal pancreatectomy(DP). Aims: The aim of study was to determine risk factors of clinical PF after DP using the stapler. Patients & methods: Twenty three patients who underwent DP between April 2006 and February 2014 were enrolled in this study. The relationship between the incidence of PF and several clinical factors (operative factors and patients background) was retrospectively analyzed. As the technique of pancreas transection, we have chosen the tri-stapler technique of all patients, regardless open or laparoscopic DP. We have defined the stapled transection line 20mm proximal from the pancreas tumor, and measured the thickness of pancreas parenchyma. Results: GradeA PF occurred in 16patients(69.6%). Clinically relevant, GradeB PF occurred in 7patients(30.4%). There is no patient in GradeC PF and no patient died by postoperative complication. Compression thickness of pancreatic stump divided by a stapler was a significant risk factor for PF on univariate analysis: GradeA group 10.2mm, GradeB group 17.6mm (mean thickness). By drawing receiver operating characteristic (ROC) curve, a pancreas thicker than 16.5mm was suggested to be the adequate cut off for predicting PF after DP using the tri-stapler. (AUC: area under the curve¼ 0.937) Conclusion: The tri-stapler closure technique seems to be an adequate transection method for patients with a pancreatic thickness less than 16.5mm to prevent occurring PF after DP.
National institute of surgery and transplantology, department of pancreatic surgery, Ukraine Background: Implementation of laparoscopic techniques could bring potential advantages in pancreatic surgery Aims: To increase the results of pancreatic resections by implementation of laparoscopic techniques. Patients & methods: In our clinic 18 laparoscopic pancreatic resections were performed in the period 2009-2013 years: 8 distal pancreatectomies, 5 enucleations and 1 central resection in patients with benign tumors of the pancreas; in 2013 we performed 4 lapariscopic pancreaticoduodenectomies in 2 patients with distal cholangiocarcinoma and 2 patients with adenocarcinoma of papilla of Vater. The mean age was 27 ± 6.4 years. There were 15 (88,2%) female and 3 (11,8%) male patients. Results: The results were compared with open surgery operations. Mean duration of the laparoscopic distal pancreatectomy was 266,7 ± 87,3 minutes, mean blood loss - 293,8±174,6 ml, postoperative in-hospital stay -10,1±3,1 days. We found no significant difference in the levels of postoperative complications. There was no significant difference in the level of intraoperative blood loss and duration of surgery, which compared with distal resections. Length of postoperative hospital stay was significantly lower when performing laparoscopic surgery. Level of intraoperative blood loss and duration of surgery was significantly lower in a group of laparoscopic enucleations. Mean duration of the laparoscopic enucleations was 84±27,9 minutes, mean blood loss e minimal in all cases, postoperative inhospital stay -6±1,9 days Conclusion: Pancreatic resections from laparoscopic approach offer several advantages, but require the development of precise indications for surgery and optimal technique for its implementation. Training in laparoscopic pancreatic surgery is necessary for wide implementation of the technique.
F-094.
F-095. Pancreaticoduodenectomy for pancreatic and periampullary lesions in the young Yi-Ming Shyr, Shin-E. Wang Taipei Veterans General Hospital, Taiwan Background: PD remains a formidable challenge to many pancreatic surgeons. There is no literature report regarding PD in the young. Aims: The purpose of this study was to clarify surgical outcomes and to assess the biological behavior of periampullary malignancy after pancreaticoduodenectomy (PD) in the young Patients & methods: Data on patients undergoing PD were retrieved for study between January, 1997, and December, 2010. Demographics, disease patterns, clinical presentations, operative findings, surgical risks, tumor pathologic characteristics, and survival outcomes were evaluated in the young patients less than 60 years old and compared with those in the older population. Results: There were 585 patients in our study. Of there, 172 were patients 60 years or younger. Higher proportions of female patients were found in the young age group compared to old in regards to sex distribution. Young group had more benign tumor compared to the old, ex. neuroendocrine tumor. The surgical mortality rates are significant less in the Young group. However, there was no significant difference in surgical morbidity and pancreatic leakage. As for the initial presentations, young group patients are often asymptomatic (4.7%) when compared to the old (1.5%, P¼0.026) but less jaundice and GI upset (P¼0.004, P¼0.012). Conclusion: PD in the young did not carry more surgical morbidity or pancreatic leakage, but had less surgical mortality, as compared to the old. Young group patients after PD had better 5 year survival in periampullary malignancy and pancreatic head adenocarcinoma
The thickness of pancreatic transection line as a risk factor for postoperative pancreatic fistula after distal pancreatectomy using the stapler Akira Muraki a, Satoshi Mizutani a, Takayuki Aimoto b, Seiji Yamagishi a, Ryousuke Nakata a, Arichika Hoshino a, Eiji Uchida c a Institute of Gastroenterology, Nippon Medical School Musashi-kosugi Hospital, Kawasaki, Japan b Kobayashi Hospital, Tokyo, Japan c Department of Surgery, Nippon Medical School, Tokyo, Japan
F-096. The first experience of the laparoscopic drainage operations for treatment of the patients with chronic pancreatitis Andrianov Alexey, Igor Khatkov, Victor Tsvirkun, Roman Izrailov, Ruslan Alikhanov Moscow Clinical Scientific Centre, Russia