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Erschienen in: World Journal of Surgery 12/2005

01.12.2005

Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?

verfasst von: Shailesh V. Shrikhande, MS, Sajid S. Qureshi, MS, Nanda Rajneesh, MS, Parul J. Shukla, MS

Erschienen in: World Journal of Surgery | Ausgabe 12/2005

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Abstract

Pancreatic anastomotic leak is the single most important factor responsible for the considerable morbidity and mortality associated with pancreaticoduodenectomy. Management of the pancreatic remnant is controversially discussed, reflecting the complexity of anastomosing a pancreas of different textures to the digestive tract. A number of studies evaluating diverse options have often provided conflicting conclusions. This information is confusing particularly to those surgeons outside of large-volume centers with broad experience and to general surgeons who perform pancreatic surgery. A PubMed search with the key words pancreaticoduodenectomy, pancreatic anastomosis, pancreaticojejunostomy, pancreaticogastrostomy, and pancreatic fistula was performed. Major series of pancreatic anastomosis published between 1990 and 2002 were studied from diverse centers worldwide. Their results with regard to pancreatic fistula, morbidity, and mortality were documented. Nine series of pancreaticojejunostomy and seven series of pancreaticogastrostomy were evaluated. Eight comparative studies evaluating the two techniques were also analyzed. A single randomized controlled trial was identified among these comparative studies. Equally good results were observed with the two techniques. Other uncommon methods of management of the pancreatic remnant (duct occlusion and ligation) were also evaluated. Pancreaticojejunostomy followed by pancreaticogastrostomy are the most favored techniques. A duct-to-mucosa anastomosis is preferred over other methods. Fistula rates of less than 5%–10% should be the standard irrespective of the technique used. Unlike in the past, mortality can be reduced even in the event of an anastomotic dehiscence, and this aspect is primarily dependent on a meticulous anastomosis based on sound surgical principles rather than the method per se. Based on the information accumulated, adherence to these specific principles could ensure a safe and reliable pancreatic anastomosis with mimimal morbidity and mortality after pancreaticoduodenectomy, even in the hands of general surgeons operating outside high-volume centers.
Literatur
1.
Zurück zum Zitat Suave L. Des pancreatectomies et specialement de la pancreatectomie cephakique. Rev Chir (Chir) 1908;37:335–385 Suave L. Des pancreatectomies et specialement de la pancreatectomie cephakique. Rev Chir (Chir) 1908;37:335–385
2.
Zurück zum Zitat Crile G Jr. The advantage of bypass operations over radical pancreanticoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet 1970;130:1049–1053PubMed Crile G Jr. The advantage of bypass operations over radical pancreanticoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet 1970;130:1049–1053PubMed
3.
Zurück zum Zitat Shapiro TM. Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs. Whipple resection in good risk patients. Ann Surg 1975;182:715–721PubMed Shapiro TM. Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs. Whipple resection in good risk patients. Ann Surg 1975;182:715–721PubMed
4.
Zurück zum Zitat Trede M, Schwall G, Saegar H. Survival after pancreaticoduodenectomy. Ann Surg 1990;211:447–458PubMed Trede M, Schwall G, Saegar H. Survival after pancreaticoduodenectomy. Ann Surg 1990;211:447–458PubMed
5.
Zurück zum Zitat Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–438PubMed Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–438PubMed
6.
Zurück zum Zitat Crist DW, Sitzmann JV, Cameron JL. Improved hospital mortality after the Whipple operation. Ann Surg 1987;206:358–373PubMed Crist DW, Sitzmann JV, Cameron JL. Improved hospital mortality after the Whipple operation. Ann Surg 1987;206:358–373PubMed
7.
Zurück zum Zitat Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993;165:68–73PubMed Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993;165:68–73PubMed
8.
Zurück zum Zitat Barnes SA, Lillemoe KD, Kaufmann HS, et al. Pancreaticoduodenectomy for benign disease. Am J Surg. 1996;171:131–135 Barnes SA, Lillemoe KD, Kaufmann HS, et al. Pancreaticoduodenectomy for benign disease. Am J Surg. 1996;171:131–135
9.
Zurück zum Zitat Martin RF, Rossi RL, Leslie KA. Long term results of pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis. Arch Surg 1996;131:247–252PubMed Martin RF, Rossi RL, Leslie KA. Long term results of pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis. Arch Surg 1996;131:247–252PubMed
10.
Zurück zum Zitat Talamini MA, Moesinger RC, Pitt HA, et al. Adenocarcinoma of the ampulla of Vater. A 28 year experience. Ann Surg 1997;225:590–600CrossRefPubMed Talamini MA, Moesinger RC, Pitt HA, et al. Adenocarcinoma of the ampulla of Vater. A 28 year experience. Ann Surg 1997;225:590–600CrossRefPubMed
11.
Zurück zum Zitat Miedema BW, Sarr MG, van Heerdeen JA, et al. Complications following pancreaticoduodenectomy. Current management. Arch Surg 1992;127:945–950PubMed Miedema BW, Sarr MG, van Heerdeen JA, et al. Complications following pancreaticoduodenectomy. Current management. Arch Surg 1992;127:945–950PubMed
12.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–260CrossRefPubMed Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–260CrossRefPubMed
13.
Zurück zum Zitat Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004;21:54–59CrossRefPubMed Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004;21:54–59CrossRefPubMed
14.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13CrossRefPubMed Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13CrossRefPubMed
15.
Zurück zum Zitat Goldsmith HS, Ghosh BC, Huvos AG. Ligation versus implantation of the pancreatic duct after pancreaticoduodenectomy. Surg Gynecol Obstet 1971;132:87–92PubMed Goldsmith HS, Ghosh BC, Huvos AG. Ligation versus implantation of the pancreatic duct after pancreaticoduodenectomy. Surg Gynecol Obstet 1971;132:87–92PubMed
16.
Zurück zum Zitat Papachristou DN, Fortner JG. Pancreatic fistula complicating pancreatectomy for malignant disease. Br J Surg 1981;68:238–240PubMed Papachristou DN, Fortner JG. Pancreatic fistula complicating pancreatectomy for malignant disease. Br J Surg 1981;68:238–240PubMed
17.
Zurück zum Zitat Friess H, Boehnert M, Shrikhande S, et al. 2002. Surgery for pancreatic cancer and the management of its complications. In Jagannath P, Hepato-Pancreato-Biliary Surgery: Current Concepts, Delhi, India, B. I. Churchill Livingstone, pp 209–222 Friess H, Boehnert M, Shrikhande S, et al. 2002. Surgery for pancreatic cancer and the management of its complications. In Jagannath P, Hepato-Pancreato-Biliary Surgery: Current Concepts, Delhi, India, B. I. Churchill Livingstone, pp 209–222
18.
Zurück zum Zitat Tran K, Van Eijck C, Di Carlo V, et al. Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 2002;236:422–428CrossRefPubMed Tran K, Van Eijck C, Di Carlo V, et al. Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 2002;236:422–428CrossRefPubMed
19.
Zurück zum Zitat Dicarlo V, Chiesa R, Pontiroli AE, et al. Pancreaticoduodenectomy with occlusion of the residual stump with neoprene injection. World J Surg 1989;13:105–111 Dicarlo V, Chiesa R, Pontiroli AE, et al. Pancreaticoduodenectomy with occlusion of the residual stump with neoprene injection. World J Surg 1989;13:105–111
20.
Zurück zum Zitat Sarr MG, Behrns KE, van Heerdeen JA. Total pancreatectomy. An objective analysis of its use in pancreatic cancer. Hepatogastroenterology 1993;40:418–421PubMed Sarr MG, Behrns KE, van Heerdeen JA. Total pancreatectomy. An objective analysis of its use in pancreatic cancer. Hepatogastroenterology 1993;40:418–421PubMed
21.
Zurück zum Zitat Aston SJ, Longmire WP Jr. Management of the pancreas after pancreaticoduodenectomy. Ann Surg 1974;179:322–327PubMed Aston SJ, Longmire WP Jr. Management of the pancreas after pancreaticoduodenectomy. Ann Surg 1974;179:322–327PubMed
22.
Zurück zum Zitat Marcus SG, Cohen H, Ranson JHC. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 1995;221:635–648PubMed Marcus SG, Cohen H, Ranson JHC. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 1995;221:635–648PubMed
23.
Zurück zum Zitat Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreaticoduodenectomy. A prospective study. Ann Surg 1999;1:41–48 Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreaticoduodenectomy. A prospective study. Ann Surg 1999;1:41–48
24.
Zurück zum Zitat Papadimitriou JD, Fotopoulus AC, Smyrniotis B, et al. Subtotal pancreaticoduodenectomy. Use of a defunctionalized loop for pancreatic stump drainage. Arch Surg 1999;134:135–139PubMed Papadimitriou JD, Fotopoulus AC, Smyrniotis B, et al. Subtotal pancreaticoduodenectomy. Use of a defunctionalized loop for pancreatic stump drainage. Arch Surg 1999;134:135–139PubMed
25.
Zurück zum Zitat Greene BS, Loubeau JM, Peoples JB, et al. Are pancreaticoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg 1991;161:45–50CrossRefPubMed Greene BS, Loubeau JM, Peoples JB, et al. Are pancreaticoenteric anastomoses improved by duct-to-mucosa sutures? Am J Surg 1991;161:45–50CrossRefPubMed
26.
Zurück zum Zitat Miyagawa S, Makuuchi M, Lygidakis NJ, et al. A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy—pancreaticojejunostomy vs. pancreaticogastrostomy. Hepatogastroenterology 1992;39:381–384PubMed Miyagawa S, Makuuchi M, Lygidakis NJ, et al. A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy—pancreaticojejunostomy vs. pancreaticogastrostomy. Hepatogastroenterology 1992;39:381–384PubMed
27.
Zurück zum Zitat Kim SW, Youk EG, Park YH. Comparison of pancreatogastrostomy and pancreatojejunostomy after pancreatoduodenectomy performed by one surgeon. World J Surg 1997;21:640–643CrossRefPubMed Kim SW, Youk EG, Park YH. Comparison of pancreatogastrostomy and pancreatojejunostomy after pancreatoduodenectomy performed by one surgeon. World J Surg 1997;21:640–643CrossRefPubMed
28.
Zurück zum Zitat Lin PW, Lee JC, Lee PC, et al. A simple, secure and universal pancreaticojejunostomy following pancreaticoduodenectomy. HPB Surg 1997;10:305–310PubMed Lin PW, Lee JC, Lee PC, et al. A simple, secure and universal pancreaticojejunostomy following pancreaticoduodenectomy. HPB Surg 1997;10:305–310PubMed
29.
Zurück zum Zitat Arnaud JP, Tuech JJ, Cervi C, et al. Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg 1999;165:357–362PubMed Arnaud JP, Tuech JJ, Cervi C, et al. Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg 1999;165:357–362PubMed
30.
Zurück zum Zitat Ohwada S, Ogawa T, Kawate S, Tanahashi Y, Iwazaki S, Tomizawa N, Yamada T, Ohya T, Morishita Y. Results of duct-to-mucosa pancreaticojejunostomy for pancreaticoduodenectomy Billroth I type reconstruction in 100 consecutive patients. J Am Coll Surg 2001;193:29–35 CrossRefPubMed Ohwada S, Ogawa T, Kawate S, Tanahashi Y, Iwazaki S, Tomizawa N, Yamada T, Ohya T, Morishita Y. Results of duct-to-mucosa pancreaticojejunostomy for pancreaticoduodenectomy Billroth I type reconstruction in 100 consecutive patients. J Am Coll Surg 2001;193:29–35 CrossRefPubMed
31.
Zurück zum Zitat Z’graggen K, Uhl W, Friess H, et al. How to do a safe pancreatic anastomosis. J. Hepatobiliary Pancreat Surg 2002;9:733–737PubMed Z’graggen K, Uhl W, Friess H, et al. How to do a safe pancreatic anastomosis. J. Hepatobiliary Pancreat Surg 2002;9:733–737PubMed
32.
Zurück zum Zitat Strasberg SM, Drebin JA, Mokadam NA, et al. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 2002;194:746–758 discussion 759–760PubMed Strasberg SM, Drebin JA, Mokadam NA, et al. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 2002;194:746–758 discussion 759–760PubMed
33.
Zurück zum Zitat Peng S, Liu Y, Mou Y, et al. Binding pancreaticojejunostomy: clinical report of 150 cases. Zhonghua Yi Xue Za Zhi 2002;82:368–370 PubMed Peng S, Liu Y, Mou Y, et al. Binding pancreaticojejunostomy: clinical report of 150 cases. Zhonghua Yi Xue Za Zhi 2002;82:368–370 PubMed
34.
Zurück zum Zitat van Berge Henegouwen MI, De Wit LT, Van Gulik TM, et al. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 1997;185:18–24PubMed van Berge Henegouwen MI, De Wit LT, Van Gulik TM, et al. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 1997;185:18–24PubMed
35.
Zurück zum Zitat O’Neil S, Pickleman J, Aranha GV. Pancreaticogastrostomy following pancreaticoduodenectomy: review of 102 consecutive cases. World J Surg 2001;25:567–571PubMed O’Neil S, Pickleman J, Aranha GV. Pancreaticogastrostomy following pancreaticoduodenectomy: review of 102 consecutive cases. World J Surg 2001;25:567–571PubMed
36.
Zurück zum Zitat Tripodi AM, Sherwin CF. Experimental transplantation of the pancreas into the stomach. Arch Surg 1934;28:345–356 Tripodi AM, Sherwin CF. Experimental transplantation of the pancreas into the stomach. Arch Surg 1934;28:345–356
37.
Zurück zum Zitat Person EC Jr, Glenn F. Pancreaticogastrostomy, experimental transplantation of the pancreas into the stomach. Arch Surg 1939;39:530–550 Person EC Jr, Glenn F. Pancreaticogastrostomy, experimental transplantation of the pancreas into the stomach. Arch Surg 1939;39:530–550
38.
Zurück zum Zitat Waugh JM, Clagett OT. Resection of the duodenum and head of pancreas for carcinoma. An analysis of thirty cases. Surgery 1946;20:224–232 Waugh JM, Clagett OT. Resection of the duodenum and head of pancreas for carcinoma. An analysis of thirty cases. Surgery 1946;20:224–232
39.
Zurück zum Zitat Delcore R, Thomas JH, Pierce GE, et al. Pancreatogastrostomy: a safe drainage procedure after pancreatoduodenectomy. Surgery 1990;108:641–645 discussion 645–647PubMed Delcore R, Thomas JH, Pierce GE, et al. Pancreatogastrostomy: a safe drainage procedure after pancreatoduodenectomy. Surgery 1990;108:641–645 discussion 645–647PubMed
40.
Zurück zum Zitat Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580–588 discussion 588–592PubMedCrossRef Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580–588 discussion 588–592PubMedCrossRef
41.
Zurück zum Zitat Kapur BM, Misra MC, Seenu V, et al. Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma. Am J Surg 1998;176:274–278CrossRefPubMed Kapur BM, Misra MC, Seenu V, et al. Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma. Am J Surg 1998;176:274–278CrossRefPubMed
42.
Zurück zum Zitat Takano S, Ito Y, Oishi H, et al. A retrospective analysis of 88 patients with pancreaticogastrostomy after pancreaticoduodenectomy. Hepatogastroenterology 2000;47:1454–1457PubMed Takano S, Ito Y, Oishi H, et al. A retrospective analysis of 88 patients with pancreaticogastrostomy after pancreaticoduodenectomy. Hepatogastroenterology 2000;47:1454–1457PubMed
43.
Zurück zum Zitat Schlitt HJ, Schmidt U, Simunec D, et al. Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br J Surg 2002;89:1245–1251CrossRefPubMed Schlitt HJ, Schmidt U, Simunec D, et al. Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br J Surg 2002;89:1245–1251CrossRefPubMed
44.
Zurück zum Zitat Mason GR. Pancreatogastrostomy as reconstruction for pancreatoduodenectomy: review. World J Surg 1999;23:221–226PubMed Mason GR. Pancreatogastrostomy as reconstruction for pancreatoduodenectomy: review. World J Surg 1999;23:221–226PubMed
45.
Zurück zum Zitat Takano S, Ito Y, Watanabe Y, et al. Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 2000;87:423–427PubMed Takano S, Ito Y, Watanabe Y, et al. Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 2000;87:423–427PubMed
46.
Zurück zum Zitat Aranha GV, Hodul P, Golts E, et al. A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 2003;7:672–682CrossRefPubMed Aranha GV, Hodul P, Golts E, et al. A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 2003;7:672–682CrossRefPubMed
47.
Zurück zum Zitat Oussoultzoglou E, Bachellier P, Bigourdan JM, et al. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004;139:327–335PubMed Oussoultzoglou E, Bachellier P, Bigourdan JM, et al. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004;139:327–335PubMed
48.
Zurück zum Zitat Mason GR, Freeark RJ. Current experience with pancreatogastrostomy. Am J Surg 1995;169:217–219CrossRefPubMed Mason GR, Freeark RJ. Current experience with pancreatogastrostomy. Am J Surg 1995;169:217–219CrossRefPubMed
49.
Zurück zum Zitat Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using single method, in 100 consecutive pancreaticoduodenectomies. Surg Today 1998;28:719–726CrossRefPubMed Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using single method, in 100 consecutive pancreaticoduodenectomies. Surg Today 1998;28:719–726CrossRefPubMed
50.
Zurück zum Zitat Bartoli FG, Arnone GB, Ravera G, et al. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Reviews and statistical meta-analysis regarding 15 years of literature. Anticancer Res 1991;11:1831–1848PubMed Bartoli FG, Arnone GB, Ravera G, et al. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Reviews and statistical meta-analysis regarding 15 years of literature. Anticancer Res 1991;11:1831–1848PubMed
51.
Zurück zum Zitat Al-Sharaf C, Ishe I, Dawiskiba S, et al. Characteristics of the gland remnant predict complications after subtotal pancreaticoduodenectomy. Dig Surg 1997;14:101–106CrossRef Al-Sharaf C, Ishe I, Dawiskiba S, et al. Characteristics of the gland remnant predict complications after subtotal pancreaticoduodenectomy. Dig Surg 1997;14:101–106CrossRef
52.
Zurück zum Zitat Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998;133:1094–1098PubMed Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998;133:1094–1098PubMed
53.
Zurück zum Zitat Hamanaka Y, Nishihara K, Hamasaki T, et al. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency duct size, and leakage. Surgery 1996;19:281–287 Hamanaka Y, Nishihara K, Hamasaki T, et al. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency duct size, and leakage. Surgery 1996;19:281–287
54.
Zurück zum Zitat Ishikawa O, Ohigashi H, Imaoka S, et al. Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreaticoduodenectomy. Arch Surg 1991;126:885–889PubMed Ishikawa O, Ohigashi H, Imaoka S, et al. Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreaticoduodenectomy. Arch Surg 1991;126:885–889PubMed
55.
Zurück zum Zitat Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000;232:419–429PubMed Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000;232:419–429PubMed
56.
Zurück zum Zitat Buchler M, Friess H, Klempa I, et al. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 1992;163:125–131PubMed Buchler M, Friess H, Klempa I, et al. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 1992;163:125–131PubMed
57.
Zurück zum Zitat Pederzoli P, Bassi C, Falconi M, et al. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Br J Surg 1994;81:265–26PubMed Pederzoli P, Bassi C, Falconi M, et al. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Br J Surg 1994;81:265–26PubMed
58.
Zurück zum Zitat Montorsi M, Zago M, Mosca F, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 1995:117:26–31PubMed Montorsi M, Zago M, Mosca F, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 1995:117:26–31PubMed
59.
Zurück zum Zitat Friess H, Beger Hg, Sulkowski U, et al. Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br J Surg 1995;82:1270–1273PubMed Friess H, Beger Hg, Sulkowski U, et al. Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br J Surg 1995;82:1270–1273PubMed
60.
Zurück zum Zitat Lowy AM, Lee JE, Piaters Pw, et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for maliganant disease. Ann Surg 1997;226:632–641CrossRefPubMed Lowy AM, Lee JE, Piaters Pw, et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for maliganant disease. Ann Surg 1997;226:632–641CrossRefPubMed
61.
Zurück zum Zitat Sikora SS, Posner MC. Management of the pancreatic stump following pancreaticoduodenectomy. Br J Surg 1995;82:1590–1597PubMed Sikora SS, Posner MC. Management of the pancreatic stump following pancreaticoduodenectomy. Br J Surg 1995;82:1590–1597PubMed
62.
Zurück zum Zitat Matsumoto Y, Fujii H, Miura K, et al. Successful pancreatojejunal anastomosis for pancreatodenectomy. Surg Gynecol Obstet 1992;175:555–562PubMed Matsumoto Y, Fujii H, Miura K, et al. Successful pancreatojejunal anastomosis for pancreatodenectomy. Surg Gynecol Obstet 1992;175:555–562PubMed
63.
Zurück zum Zitat Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients. Surgery 1998;123:617–621PubMed Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients. Surgery 1998;123:617–621PubMed
64.
Zurück zum Zitat Hwang TL, Jan YY, chen MF. Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy. Hepatogastroenterology 1996;43:275–277PubMed Hwang TL, Jan YY, chen MF. Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy. Hepatogastroenterology 1996;43:275–277PubMed
65.
Zurück zum Zitat Biehl T, Traverso LW. Is stenting necessary for a successful pancreatic anastomosis? Am J Surg 1992;163:530–532CrossRefPubMed Biehl T, Traverso LW. Is stenting necessary for a successful pancreatic anastomosis? Am J Surg 1992;163:530–532CrossRefPubMed
66.
Zurück zum Zitat Yoshimi F, Ono H, Asato Y, et al. Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital. Surg Today 1996;26:665–667CrossRefPubMed Yoshimi F, Ono H, Asato Y, et al. Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital. Surg Today 1996;26:665–667CrossRefPubMed
67.
Zurück zum Zitat Shibuya T, Uchiyama K, Imai S, et al. Improvement of pancreaticojejunostomy in pancreatoduodenectomy. Int Surg 1995;80:57–60PubMed Shibuya T, Uchiyama K, Imai S, et al. Improvement of pancreaticojejunostomy in pancreatoduodenectomy. Int Surg 1995;80:57–60PubMed
68.
Zurück zum Zitat Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy. A prospective study. Ann Surg 1999;229:41–48CrossRefPubMed Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy. A prospective study. Ann Surg 1999;229:41–48CrossRefPubMed
69.
Zurück zum Zitat Shrikhande S, Jagannath P. Current options in diagnosis and management of ampullary carcinoma. Indian J Surg 2003;65:347–353 Shrikhande S, Jagannath P. Current options in diagnosis and management of ampullary carcinoma. Indian J Surg 2003;65:347–353
70.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137CrossRefPubMed Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137CrossRefPubMed
Metadaten
Titel
Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?
verfasst von
Shailesh V. Shrikhande, MS
Sajid S. Qureshi, MS
Nanda Rajneesh, MS
Parul J. Shukla, MS
Publikationsdatum
01.12.2005
Erschienen in
World Journal of Surgery / Ausgabe 12/2005
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0137-3

Weitere Artikel der Ausgabe 12/2005

World Journal of Surgery 12/2005 Zur Ausgabe

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S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.