Erschienen in:
01.07.2009 | SSAT/SAGES Joint Symposium
The Pancreatic Anastomosis: The Danger of a Leak, Which Anastomotic Technique is Better?
verfasst von:
David B. Adams
Erschienen in:
Journal of Gastrointestinal Surgery
|
Ausgabe 7/2009
Einloggen, um Zugang zu erhalten
Excerpt
Every pancreatic surgeon has a favorite way to construct a pancreatic anastomosis after pancreatoduodenectomy. All represent variations on three fundamental techniques: the end-to-side pancreatic duct to jejunal mucosa anastomosis, the end-to-end invaginating pancreaticojejunostomy, and the end-to-side pancreaticogastrostomy.
1 In the pancreatic anastomotic leak study group report of 1,507 patients, pancreaticojejunostomy was utilized in the majority of patients (87.6%) and pancreaticogastrostomy was utilized in 12.4%.
2 An internal stent was placed across the anastomosis in about half of the patients. A duct to mucosa anastomosis was constructed in two thirds of patients, and a third of the patients had a dunking type of anastomosis. In a PubMed search for “pancreatic anastomosis,” over 1,700 publications are listed over the past five decades. The titles are notable for adjectives such as new, modified, simpler, reliable, secure, safe, novel, and best of all, easier. The Nobel physicist Ernest Rutherford’s remark that “all science is either physics or stamp collecting,” is substantiated by the many published individual reports of successful pancreatic anastomotic techniques. …
