Title: Does the Type of Pancreaticojejunostomy After Whipple Alter the Leak Rate?
Abstract: Leakage of digestive juices from the pancreas with their unpredictable sequelae continues to pose a challenge to surgeons since Whipple's addition of a pancreaticojejunostomy [ [1] Whipple A.O. A reminiscence: pancreatoduodenectomy. Rev Surg. 1963; 20: 221-225 PubMed Google Scholar ] to the classic Kausch-Whipple pancreatoduodenectomy in 1942 [ 2 Kausch W. Das carcinoma der papilla und seine radikale entfernung. Beitr Klin Chir. 1912; 78: 29-33 Google Scholar , 3 Whipple A.O. The rationale of radical surgery for cancer of the pancreas and ampullary region. Ann Surg. 1941; 114: 612-615 Crossref PubMed Google Scholar ]. Although the mortality associated with pancreatoduodenectomy has been dramatically reduced over the past 70 years (from 20% to <3%), morbidity rates have remained stubbornly constant at approximately 40% [ 4 Crile Jr., G. The advantage of bypass operations over radical pancreaticoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet. 1970; 130: 1049-1053 PubMed Google Scholar , 5 Herter F.P. Cooperman A.M. Ahlborn T.N. et al. Surgical experience with pancreatic and periampullary cancer. Ann Surg. 1982; 195: 274-281 Crossref PubMed Google Scholar , 6 Poon R.T.P. Fan S.T. Decreasing the pancreatic leak rate after pancreaticoduodenectomy. Adv Surg. 2008; 42: 33-48 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 7 Yeo C.J. Cameron J.L. Sohn T.A. et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226: 248-260 Crossref PubMed Scopus (1208) Google Scholar , 8 Poon R.T.P. Fan S.T. Chu K.M. et al. Standards of pancreaticoduodenectomy in a tertiary referral centre in Hong Kong: retrospective case series. Hong Kong Med J. 2002; 8: 249-254 PubMed Google Scholar , 9 Neoptolemos J.P. Russell R.C. Bramhall S. et al. Low mortality following resection for pancreatic and periampullary tumors in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg. 1997; 84: 1370-1376 Crossref PubMed Scopus (292) Google Scholar , 10 Jimenez R.E. Fernandez-del Castillo C. Rattner D.W. et al. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg. 2000; 231: 293-300 Crossref PubMed Scopus (152) Google Scholar , 11 Bottger T.C. Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 patients. World J Surg. 1999; 23: 164-171 Crossref PubMed Scopus (150) Google Scholar , 12 Trede M. Schwall G. Saeger H.D. Survival after pancreaticoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg. 1990; 211: 447-458 Crossref PubMed Google Scholar , 13 Fernandez-del Castillo C. Rattner D.W. Warshaw A.L. Standards for pancreatic resection in the 1990s. Arch Surg. 1995; 130: 295-299 Crossref PubMed Google Scholar , 14 Cameron J.L. Pitt H.A. Yeo C.J. et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993; 217: 430-435 Crossref PubMed Google Scholar ]. Although the list of complications associated with a Whipple operation is substantial, an uncontrolled pancreatic leak and its associated downstream effectors of sepsis, hemorrhage, and multiorgan failure remain the most dramatic and lethal. Although the mortality rates associated with a pancreatic leak have been substantially reduced by the application of modern critical care, nutritional support and percutaneous catheter drainage techniques, systemic sepsis, and visceral pseudoaneurysms still occur, and when present, result in mortality rates of up to 40% [ 11 Bottger T.C. Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 patients. World J Surg. 1999; 23: 164-171 Crossref PubMed Scopus (150) Google Scholar , 15 Trede M. Schwall G. The complications of pancreatectomy. Ann Surg. 1998; 207: 39-47 Crossref Google Scholar , 16 Cullen J.J. Sarr M.G. Ilstrup D.M. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg. 1994; 168: 295-298 Abstract Full Text PDF PubMed Scopus (247) Google Scholar , 17 van Berge Henegouwen M.I. De Wit L.T. Van Gulik T.M. et al. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg. 1997; 185: 18-24 Crossref PubMed Google Scholar , 18 Grobmyer S.R. Rivadeneira D.E. Goodman C.A. et al. Pancreatic anastomotic failure after pancreaticoduodenectomy. Am J Surg. 2000; 180: 117-120 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar , 19 Buchler M.W. Friess H. Wagner M. et al. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000; 87: 883-889 Crossref PubMed Scopus (272) Google Scholar ]. Efforts to reduce the 10% to 25% incidence of pancreatic-enteric anastomotic leaks have invigorated surgeons to explore innovative technical modifications to this portion of the operation [ 7 Yeo C.J. Cameron J.L. Sohn T.A. et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226: 248-260 Crossref PubMed Scopus (1208) Google Scholar , 15 Trede M. Schwall G. The complications of pancreatectomy. Ann Surg. 1998; 207: 39-47 Crossref Google Scholar , 16 Cullen J.J. Sarr M.G. Ilstrup D.M. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg. 1994; 168: 295-298 Abstract Full Text PDF PubMed Scopus (247) Google Scholar , 20 Bassi C. Dervenis C. Buttutini G. et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138: 8-13 Abstract Full Text Full Text PDF PubMed Scopus (1228) Google Scholar ]. More than 1700 publications commenting on pancreatic anastomosis have been listed in PubMed over the past 50 years chronicling the employment of different reconstructive organs, sewing techniques, pancreatic duct stenting methods, pharmacologic manipulation of pancreatic secretion, application of topical adhesives, and methods of external drainage [ [21] Adams D.B. The pancreatic anastomosis: the danger of a leak which anastomotic technique is better?. J Gastrointest Surg. 2009; 13: 1182-1183 Crossref PubMed Scopus (21) Google Scholar ]. Whenever one encounters a body of literature this extensive that focuses on one technical aspect of an operation, it generally means: (1) it is viewed as an important problem by surgeons, and (2) no adequate solution to the problem exists.
Publication Year: 2010
Publication Date: 2010-09-01
Language: en
Type: review
Indexed In: ['crossref', 'pubmed']
Access and Citation
Cited By Count: 13
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