Erschienen in:
01.07.2009 | SSAT/SAGES Joint Symposium
Stents, Glue, Etc.: Is Anything Proven to Help Prevent Pancreatic Leaks/Fistulae?
verfasst von:
Richard D. Schulick, Kiyoshi Yoshimura
Erschienen in:
Journal of Gastrointestinal Surgery
|
Ausgabe 7/2009
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Excerpt
Of the three anastomoses performed with pancreaticoduodenectomy, the “Achilles heal” is the pancreatic anastomosis. When Allen O. Whipple, M.D. reported his series of three patients who underwent pancreaticoduodenectomy at the American Surgical Association in 1935, he described a two-stage operation in which the first stage included a cholecystogastrostomy and a gastrojejunostomy to resolve jaundice and gastric outlet obstruction.
1 In the second operation, the patient underwent resection of the pancreatic head and duodenum. The distal bile duct was ligated and the first portion of the duodenum oversewn (biliary and gastrointestinal continuity was established with the first operation). The pancreatic remnant was oversewn and left to fistulize through a surgically placed drain. Towards the end of his career, he reported his one-stage procedure in which the pancreatic remnant was anastomosed to the jejunum.
2 The high morbidity and mortality rates associated with this operation are principally due to pancreatic leaks. Since the 1980s, multiple institutions reported considerably lower mortality rates, but pancreatic leak remained a considerable source of morbidity.
3‐
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