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The Impact of Pancreatic Duct Drainage Following Pancreaticojejunostomy on Clinical Outcome

Published on Aug 1, 2012in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-012-1852-3
Sheraz R. Markar30
Estimated H-index: 30
,
Soumil Vyas10
Estimated H-index: 10
+ 2 AuthorsMassimoMalago49
Estimated H-index: 49
Abstract
Background The aim of this meta-analysis is to evaluate the effect of stenting the pancreatic duct during pancreaticojejunostomy formation on perioperative outcomes.
  • References (36)
  • Citations (15)
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References36
Newest
#1Fuyuhiko Motoi (Tohoku University)H-Index: 29
#2Shinichi Egawa (Tohoku University)H-Index: 38
Last. Michiaki Unno (Tohoku University)H-Index: 48
view all 5 authors...
Background: Postoperative pancreatic fistula (POPF) remains one of the most common causes of morbidity following pancreaticoduodenectomy (PD). This randomized trial examined whether external stent drainage of the pancreatic duct decreases the rate of POPF after PD and subsequent pancreaticojejunostomy (PJ). Methods: Consecutive patients who underwent PD with subsequent construction of a duct-to-mucosa PJ were randomized into a stented and a non-stented group. The primary outcome was the incidenc...
102 CitationsSource
#1Jonathan F. FinksH-Index: 18
#2Nicholas H. Osborne (UM: University of Michigan)H-Index: 19
Last. John D. Birkmeyer (UM: University of Michigan)H-Index: 78
view all 3 authors...
Background There were numerous efforts in the United States during the previous decade to concentrate selected surgical procedures in high-volume hospitals. It remains unknown whether referral patterns for high-risk surgery have changed as a result and how operative mortality has been affected. Methods We used national Medicare data to study patients undergoing one of eight different cancer and cardiovascular operations from 1999 through 2008. For each procedure, we examined trends in hospital v...
735 CitationsSource
#1Patrick PessauxH-Index: 44
#2Alain SauvanetH-Index: 74
Last. Jean-Pierre ArnaudH-Index: 43
view all 8 authors...
155 CitationsSource
#1KurokiTamotsuH-Index: 20
#2Yoshitsugu TajimaH-Index: 21
Last. Takashi KanematsuH-Index: 57
view all 5 authors...
Objectives: We prospectively investigated the efficacy of an external pancreatic duct stent to prevent pancreatic fistula in the nonfibrotic pancreas after pancreaticojejunostomy, in which the degree of pancreatic fibrosis was assessed objectively by using dynamic magnetic resonance imaging (MRI). Methods: Among the 67 consecutive patients who underwent pancreatic head resection, 45 patients were judged to have a normal pancreas without fibrosis based on the preoperative assessment of pancreatic...
30 CitationsSource
#1Masajitani (Wakayama Medical University)H-Index: 28
#2Manabu Kawai (Wakayama Medical University)H-Index: 28
Last. Hirokiyamaue (Wakayama Medical University)H-Index: 44
view all 7 authors...
Abstract Background A stent often is placed across the pancreaticojejunostomy. However, there is no report compared between internal drainage and external drainage. Methods We conducted a prospective randomized trial ( NCT00628186 registered at http://ClinicalTrials.gov ) with 100 patients who underwent pancreaticoduodenectomy and we compared the effects on postoperative course. Results The incidence of pancreatic fistula according to the International Study Group on Pancreatic Fistula criteria ...
62 CitationsSource
#1Vassilios Smyrniotis (UoA: National and Kapodistrian University of Athens)H-Index: 25
#2Nikolaos Arkadopoulos (UoA: National and Kapodistrian University of Athens)H-Index: 23
Last. Ioannis Vassiliou (UoA: National and Kapodistrian University of Athens)H-Index: 13
view all 8 authors...
Aim This study’s aim is to evaluate the effectiveness of using an internal stent when fashioning a duct-to-mucosa pancreatojejunostomy on preventing pancreatic fistula formation, as well as on the overall outcome for patients undergoing pancreaticoduodenectomy.
40 CitationsSource
#1David FuksH-Index: 30
#2Guillaume PiessenH-Index: 28
Last. Jean Marc RegimbeauH-Index: 41
view all 17 authors...
Abstract Background Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim ...
167 CitationsSource
The quantile approximation method has recently been proposed as a simple method for deriving confidence intervals for the treatment effect in a random effects meta-analysis. Although easily implemented, the quantiles used to construct intervals are derived from a single simulation study. Here it is shown that altering the study parameters, and in particular introducing changes to the distribution of the within-study variances, can have a dramatic impact on the resulting quantiles. This is furthe...
29 CitationsSource
#1RonnieTung-PingPoonH-Index: 89
#2Sheung-TatFanH-Index: 102
Last. John B. WongH-Index: 110
view all 7 authors...
260 CitationsSource
#1Moritz N. Wente (Heidelberg University)H-Index: 37
#2Shailesh V. Shrikhande (Heidelberg University)H-Index: 30
Last. Markus W. Büchler (Heidelberg University)H-Index: 127
view all 7 authors...
Abstract Objective Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the commonly preferred methods of anastomosis after pancreaticoduodenectomy (PD). The ideal choice of anastomosis remains a matter of debate. Data Sources Articles published until end of March 2006 comparing PJ and PG after PD were searched. Study Selection Two reviewers independently assessed quality and eligibility of the studies and extracted data for further analysis. Meta-analysis was performed with a random-...
191 CitationsSource
Cited By15
Newest
#1Yuancong Jiang (ZJU: Zhejiang University)
#2Qin Chen (LMB: Laboratory of Molecular Biology)
Last. Sheng Yan (ZJU: Zhejiang University)H-Index: 14
view all 9 authors...
Background: There is no specific evidence regarding the benefits of external and internal pancreatic duct stents after pancreaticoduodenectomy since pancreatic fistula (grade A) have been redefined with no clinical treatment effect. We aimed to reevaluate the prognostic value of external and internal stents in clinically relevant postoperative pancreatic fistula over pancreaticoduodenectomy.Methods: PubMed, Web of Science, EMBASE and the Cochrane Database were specifically searched for pertinent...
Source
#1Yien Xiang (JLU: Jilin University)H-Index: 1
#2Jiacheng Wu (JLU: Jilin University)
Last. Xuewen Zhang (JLU: Jilin University)H-Index: 10
view all 8 authors...
ABSTRACTIntroduction: Postoperative pancreatic fistula is the most troublesome complication after pancreaticoduodenectomy, and is an on-going area of concern for pancreatic surgeons. The specific p...
Source
#1Masaki Sunagawa (Nagoya University)H-Index: 1
#2Yukihiro Yokoyama (Nagoya University)H-Index: 35
Last. Masato Nagino (Nagoya University)H-Index: 63
view all 8 authors...
Abstract Background This study sought to investigate the utility of constant negative pressure for external drainage of the main pancreatic duct in preventing postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. Methods Only patients with soft pancreas were included. In the former period (July 2013 to May 2015), gravity dependent drainage was applied (gravity dependent drainage group), and in the latter period (June 2015 to November 2016), constant negative pressure drainage (neg...
Source
#1Camilo Correa-Gallego (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 19
#2Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 68
As recently as 30 years ago, major pancreatic resections were associated with morbidity and mortality rates that were considered prohibitive by many. Over the last several decades, through better training, technical advances, and the development of intensive perioperative care and interventional endoscopy and radiology, these procedures have become significantly safer. Pancreaticoduodenectomy is now associated with postoperative mortality as low as 1% in many high-volume centers.
Source
#1Yajie ZhaoH-Index: 3
#2Jianwei ZhangH-Index: 5
Last. Chengfeng WangH-Index: 5
view all 8 authors...
The technique of pancreatic duct stenting during pancreatic anastomosis can markedly reduce the incidence of postoperative pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The method of drainage includes using either an external or an internal stent; the meta-analysis result shows us that there were no differences in the rates of postoperative complications between PD using internal stents and PD using external stents; internal stents may be more favorable during postoperative managem...
2 CitationsSource
#1Gang Wang (HMU: Harbin Medical University)H-Index: 10
#2Le Li (HMU: Harbin Medical University)H-Index: 6
Last. Bei Sun (HMU: Harbin Medical University)H-Index: 21
view all 9 authors...
ABSTRACTPurpose: To compare the early efficacy of external versus internal pancreatic duct drainage after pancreaticoduodenectomy (PD), providing clinical evidence for selecting the optimal approach to pancreatic duct drainage. Material and Methods: The clinical data of 395 consecutive patients undergoing PD from 2006 to 2013 were analyzed retrospectively. All the patients were divided into external and internal drainage group. Intraoperative blood loss, surgery duration, postoperative hospitali...
2 CitationsSource
#1Kai Yu (ZJU: Zhejiang University)H-Index: 2
#2Wei Li (ZJU: Zhejiang University)H-Index: 2
Last. Jinhui Zhu (ZJU: Zhejiang University)H-Index: 6
view all 6 authors...
Background. The aim of this study was to introduce a novel technique of pancreaticojejunostomy, namely, mesh inner embedding and outer binding pancreaticojejunostomy, and to evaluate wound healing after this operation in piglets. Methods. Thirty-six domestic piglets were randomly divided into 2 groups after pancreaticoduodenectomy: the mesh inner embedding and outer binding pancreaticojejunostomy group (n = 18) and the conventional double-deck invaginated pancreaticojejunostomy group (n = 18). B...
Source
#1Patel KH-Index: 4
#2Anthony F. TetaH-Index: 5
Last. Peter DeVitoH-Index: 3
view all 6 authors...
Abstract Background Postoperative pancreatic fistula formation (POPF) remains one of the most common and detrimental complications following pancreaticojejunostomy (PJ). The aim of this meta-analysis is to analyze the efficacy of external pancreatic duct stent placement in preventing POPF formation following PJ. Methods The primary end-point was the incidence of POPF formation following pancreaticoduodenectomy (PD) in the presence and absence of external stent placement. Secondary outcomes exami...
10 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Background Postoperative pancreatic fistula is a significant contributor to morbidity following proximal and distal pancreatic resections. In recent decades, the incidence of fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of pancreatic fistula.
33 CitationsSource
#2Thoens JonathanH-Index: 1
Last. DeVito PeterH-Index: 1
view all 7 authors...
Abstract Background: Two methods of pancreatic duct decompression following pancreaticoduodenectomy (PD) are currently employed, the internal and external pancreatic duct stent. Previous analysis of the efficacy of ductal decompression following PD has been confounded by either including both the internal and external stent method or by small sample size. The aim of this meta-analysis was to analyze the efficacy of the external pancreatic duct stent method alone in preventing Post-Operative Panc...
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