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A prospective randomized controlled trial of internal versus external drainage with pancreaticojejunostomy for pancreaticoduodenectomy

Published on Jun 1, 2010in American Journal of Surgery2.201
· DOI :10.1016/j.amjsurg.2009.04.017
Masajitani28
Estimated H-index: 28
(Wakayama Medical University),
Manabu Kawai28
Estimated H-index: 28
(Wakayama Medical University)
+ 4 AuthorsHirokiyamaue44
Estimated H-index: 44
(Wakayama Medical University)
Abstract
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 was not different (external, 20%; vs internal, 26%), and the incidence of the other complications was similar between stent types. The median postoperative hospital stay was 21 days (range, 8–163 d) in the internal drainage group, which was shorter than the median stay of 24 days (range, 21–88 d) in the external drainage group (P = .016). Conclusions Both internal drainage and external drainage were safety devices for pancreaticojejunostomy. Internal drainage simplifies postoperative managements and it might shorten postoperative stay for pancreaticoduodenectomy.
  • References (27)
  • Citations (62)
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References27
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#1Govindhasamy Rajarathinam (Stanley Medical College)H-Index: 3
#2Devy Gounder Kannan (Stanley Medical College)H-Index: 11
Last. Rajagopal Surendran (Stanley Medical College)H-Index: 12
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Objective & background data. Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH). Material and methods. Between January 1998 and...
35 CitationsSource
#1Baki Topal (Katholieke Universiteit Leuven)H-Index: 27
#2S Van de SandeH-Index: 1
Last. Freddy Penninckx (Katholieke Universiteit Leuven)H-Index: 52
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Background: Despite the persistence of large differences in operative mortality rates between centres, the value of centralization of pancreaticoduodenectomy (PD) remains under debate. This cohort study analysed the effect of centralization of PD on nationwide hospital mortality and length of hospital stay in Belgium. Methods: Data on in-hospital mortality and duration of hospital stay after PD from 2000 to 2004 were obtained from the Belgian national registry database. Analysis of mortality and...
72 CitationsSource
#1Moritz N. Wente (Heidelberg University)H-Index: 37
#2Claudio Bassi (University of Verona)H-Index: 80
Last. Markus W. Büchler (Heidelberg University)H-Index: 127
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Background Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. Methods After...
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#1Hans G. Beger (University of Ulm)H-Index: 77
#2Frank GansaugeH-Index: 32
Last. Bertram PochH-Index: 21
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Abstract Pancreatic head resection is a major surgical procedure and even today is linked to considerable risk for severe complications. In high-volume centers, morbidity and mortality after pancreatic head resection decreased to below 5%. In the authors’ monoinstitutional experiences including 1315 patients with malignant lesion and benign tumor, the frequency and severity of local as well as systemic complications after pancreatic head resection are reported. Between 1982 and 2004, 1315 patien...
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#2Sheung-TatFanH-Index: 102
Last. John B. WongH-Index: 110
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Pancreaticoduodenectomy is the treatment of choice for patients with resectable carcinoma of the pancreatic head and periampullary region. In recent years, mortality rate of pancreaticoduodenectomy has declined to <5% in many institutions around the world.1–4 However, pancreatic fistula still occurs in 5% to 40% of patients after pancreaticoduodenectomy, depending on the definition of leakage.5–8 The reduction in operative mortality over the past few decades has not been accompanied by a notable...
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#1Wande B. PrattH-Index: 17
#2Shishir K. MaithelH-Index: 38
Last. Charles M. VollmerH-Index: 40
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Pancreatic fistula is widely regarded as the most ominous of complications following pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modifi...
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#1Michelle L. DeOliveira (Johns Hopkins University)H-Index: 15
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Last. P.-A. Clavien (UZH: University of Zurich)H-Index: 97
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Mortality associated with pancreaticoduodenectomy (PD) has decreased dramatically to less than 5% over the past 2 decades in high-volume centers,1–6 but persistent high morbidity rates have remained an important concern for patients, healthcare providers, and payers. While mortality is an objective and easily quantifiable outcome parameter, morbidity is only poorly defined, and this shortcoming has severely hampered conclusive comparisons among centers and within the same institution over time.7...
543 CitationsSource
#1Jordan M. Winter (Johns Hopkins University)H-Index: 36
#2John L. Cameron (Johns Hopkins University)H-Index: 13
Last. Charles J. Yeo (Johns Hopkins University)H-Index: 127
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Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and strati...
233 CitationsSource
#1Manabu KawaiH-Index: 28
#2MasajitaniH-Index: 28
Last. HirokiyamaueH-Index: 44
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Objective: The aim of this study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications.
264 CitationsSource
#1MasajitaniH-Index: 28
#2Hiroshi TerasawaH-Index: 9
Last. HirokiyamaueH-Index: 44
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Pylorus-preserving pancreaticoduodenectomy (PpPD) is an aggressive surgery involving pancreatic head resection for periampullary lesions. Persistent complications of PpPD have been reported and include pancreatic fistula, intra-abdominal abscess, intra-abdominal hemorrhage, and delayed gastric emptying (DGE).1–4 Pancreatic fistula is associated with all of these postoperative complications and contributes to overall morbidity and mortality.5–9 DGE is not always associated with pancreatic anastom...
221 CitationsSource
Cited By62
Newest
#1Hiroki Yamaue (Wakayama Medical University)H-Index: 45
The first report of pancreatoduodenectomy was the abstract of Japan Surgical Society in 1946 by Kuru, followed by a publication by Yoshioka (Geka, 1950). The first report of total pancreatectomy was done by Honjo in 1950 (Shujutsu). Thus, the history of pancreatic surgery in Japan dawned in the 1950s. From 1970 to 1980, the American surgeon Fortner had reported the drastic concept of regional pancreatectomy with extensive dissection of vessels and connective tissues around the pancreas. A lot of...
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#1Yuancong Jiang (ZJU: Zhejiang University)
#2Qin Chen (LMB: Laboratory of Molecular Biology)
Last. Sheng Yan (ZJU: Zhejiang University)H-Index: 14
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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
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Background Despite the significant improvement concerning perioperative mortality, pancreatoduodenectomy is still a challenging procedure. Pancreatic fistula is the most common complication underlying 30-day mortality. More than 61 surgical techniques of pancreatic anastomosis with a vast number of variations have been published. Moreover, various risk factors favoring the development of postoperative pancreatic fistulas have been identified.
1 CitationsSource
#1Guoqiang Zhang (NCU: Nanchang University)H-Index: 2
#2Xiao-Hua Li (NCU: Nanchang University)H-Index: 1
Last. Yong Li (NCU: Nanchang University)H-Index: 1
view all 7 authors...
Abstract Background The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF. Materials and methods A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and o...
1 CitationsSource
#1Yuji Kitahata (Wakayama Medical University)H-Index: 12
#2Seiko Hirono (Wakayama Medical University)H-Index: 28
Last. Hirokiyamaue (Wakayama Medical University)H-Index: 44
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Purpose Although the mortality rate for pancreaticoduodenectomy (PD) has decreased to around 2.8–5% in high-volume centers, postoperative complications are still common in 30–50% of cases. Preoperative exercise, called “prehabilitation,” has been recently reported to reduce the frequency of complications after surgery. This study aims to evaluate the impact of the intensive perioperative rehabilitation on improvement of surgical outcomes for patients undergoing PD.
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#1Seiko Hirono (Wakayama Medical University)H-Index: 28
#2Manabu Kawai (Wakayama Medical University)H-Index: 28
Last. Hirokiyamaue (Wakayama Medical University)H-Index: 44
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Purpose Internal stents used during pancreaticoduodenectomy (PD) are generally spontaneously passed through the rectum by defecation. However, we encountered six patients with internal stents that migrated into the bile duct after PD. We herein report the outcomes of these six patients and the usefulness of double-balloon enteroscopy (DBE) for removal of such stents from the bile duct.
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#1Norbert Hüser (TUM: Technische Universität München)H-Index: 17
#2Volker Aßfalg (TUM: Technische Universität München)H-Index: 4
Last. HelmutFriess (TUM: Technische Universität München)H-Index: 82
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Pylorus-preserving partial pancreaticoduodenectomy is considered to be one of the most demanding and comprehensive operative procedures in visceral surgery and is usually performed for malignant lesions of the pancreatic head, the distal bile duct, or the duodenum. Numerous modalities of this procedure, which can be structurally divided into exploration, resection, and reconstruction, have been defined. The particularly determining relevance of postoperative pancreatic fistulas probably causes t...
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#1Atsushi Shimizu (Wakayama Medical University)H-Index: 15
#2Manabu Kawai (Wakayama Medical University)H-Index: 28
Last. Hirokiyamaue (Wakayama Medical University)H-Index: 44
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Background/Aims In pancreatoduodenectomy (PD), the adverse impact of tissue edema owing to intraoperative fluid overload remains unclear. This study aims to evaluate how visceral tissue edema due to fluid overload affects severe postoperative complications after PD. It aims to clarify the usefulness of assessment by computed tomography (CT) of postoperative tissue edema.
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