TY - JOUR
T1 - Efficacy of the omental roll-up technique in pancreaticojejunostomy as a strategy to prevent pancreatic fistula after pancreaticoduodenectomy
AU - Choi, Sae Byeol
AU - Lee, Jin Suk
AU - Kim, Wan Bae
AU - Song, Tae Jin
AU - Suh, Sung Ock
AU - Choi, Sang Yong
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/2
Y1 - 2012/2
N2 - Background: Most morbidity and mortality are caused by a pancreatic fistula after pancreaticoduodenectomy (PD), and its prevention is the major concern. We applied the omental roll-up technique around pancreaticojejunostomy and investigated the effectiveness of this technique to prevent a pancreatic fistula. Design: Retrospective study. Setting: Tertiary hepatobiliary and pancreas surgery clinic, Korea University Guro Hospital, Seoul. Patients: Between March 1, 2009, and March 31, 2011, 68 patients underwent PD. The patients were divided into 2 groups according to the surgical application of the omental roll-up technique around the PJ site: group 1 (those who did not undergo the omental roll-up technique) compared with group 2 (those who did undergo the omental roll-up technique). Main Outcome Measure: The occurrence of a pancreatic fistula. Results: No differences were noted in the clinical characteristics, including patients' demographics and operation- related factors, between the 2 groups. A pancreatic fistula occurred in 23 of 39 patients in group 1 (59%) and in 6 of 29 patients in group 2 (20.7%). Group 2 had a significantly lower incidence of pancreatic fistula (P=.002), and these fistulas were classified as being grade A using the International Study Group on Pancreatic Fistula Definition showing a transient high amylase level in the drainage fluid without significantly affecting the patient's recovery. Drain removal was performed earlier in group 2 (P<.001). Mean postoperative hospital stay was 23.4 days in group 1 compared with 15.9 days in group 2 (P=.009). Overall mortality was 1.5%; however, no deaths were related to a pancreatic fistula. Conclusions: The omental roll-up technique for the PJ site definitely reduced the occurrence of a pancreatic fistula. Therefore, the omental roll-up technique is a simple and effective strategy to prevent a pancreatic fistula.
AB - Background: Most morbidity and mortality are caused by a pancreatic fistula after pancreaticoduodenectomy (PD), and its prevention is the major concern. We applied the omental roll-up technique around pancreaticojejunostomy and investigated the effectiveness of this technique to prevent a pancreatic fistula. Design: Retrospective study. Setting: Tertiary hepatobiliary and pancreas surgery clinic, Korea University Guro Hospital, Seoul. Patients: Between March 1, 2009, and March 31, 2011, 68 patients underwent PD. The patients were divided into 2 groups according to the surgical application of the omental roll-up technique around the PJ site: group 1 (those who did not undergo the omental roll-up technique) compared with group 2 (those who did undergo the omental roll-up technique). Main Outcome Measure: The occurrence of a pancreatic fistula. Results: No differences were noted in the clinical characteristics, including patients' demographics and operation- related factors, between the 2 groups. A pancreatic fistula occurred in 23 of 39 patients in group 1 (59%) and in 6 of 29 patients in group 2 (20.7%). Group 2 had a significantly lower incidence of pancreatic fistula (P=.002), and these fistulas were classified as being grade A using the International Study Group on Pancreatic Fistula Definition showing a transient high amylase level in the drainage fluid without significantly affecting the patient's recovery. Drain removal was performed earlier in group 2 (P<.001). Mean postoperative hospital stay was 23.4 days in group 1 compared with 15.9 days in group 2 (P=.009). Overall mortality was 1.5%; however, no deaths were related to a pancreatic fistula. Conclusions: The omental roll-up technique for the PJ site definitely reduced the occurrence of a pancreatic fistula. Therefore, the omental roll-up technique is a simple and effective strategy to prevent a pancreatic fistula.
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U2 - 10.1001/archsurg.2011.865
DO - 10.1001/archsurg.2011.865
M3 - Article
C2 - 22351908
AN - SCOPUS:84863115891
VL - 147
SP - 145
EP - 150
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 2
ER -