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Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

Published on Sep 11, 2018in Zentralblatt Fur Chirurgie0.62
· DOI :10.1055/a-0632-1977
Jessica Hafke , Cornelius van Beekum + 3 AuthorsTim R. Glowka5
Estimated H-index: 5
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Abstract
Hintergrund Die Magenentleerungsstorung (MES) ist die haufigste Komplikation nach partieller Pankreatoduodenektomie. Wahrend eine ante- oder retrokolische Lage keinen Einfluss auf die Haufigkeit einer MES hat, wurde wiederholt postuliert, dass eine infrakolische im Gegensatz zur suprakolischen Duodenoenterostomie durch die gestreckte Position des Magenausgangs vorteilhaft ist. Beide Formen der retrokolischen Rekonstruktion wurden bislang nicht miteinander verglichen. Patienten 138 Patienten wurden zwischen 2011 und 2017 an unserer Klinik einer pyloruserhaltenden Pankreatoduodenektomie mit retrokolischer 1-Schlingen-Rekonstruktion unterzogen. Hiervon wurden 105 supra- und 33 infrakolisch rekonstruiert und bez. demografischer Faktoren, Diagnose, Vorerkrankungen, intraoperativer Charakteristika, Krankenhausverweildauer, Morbiditat und Mortalitat und der Entwicklung einer MES miteinander verglichen. Alle Komplikationen wurden gemas der ISGPS-Klassifikationen (ISGPS: International Study Group of Pancreatic Surgery) dokumentiert. Ergebnisse Beide Gruppen waren bez. Grund- und Vorerkrankungen, perioperativem Verlauf und Komplikationsspektrum miteinander vergleichbar. Eine MES trat in beiden Gruppen gleich haufig auf (MES Grad A/B/C suprakolisch 25/14/10 und infrakolisch 12/5/2, p = 0,274). Tritt eine MES auf, so sind Intensivstationsaufenthalt (p = 0,007) und Krankenhausaufenthalt (p = 0,001) signifikant verlangert. Die Risikofaktoranalyse zeigte eine Haufung von MES bei vorbestehendem Diabetes mellitus (p = 0,047) und Majorkomplikationen (Clavien Grad III – V, p = 0,048), wohingegen der Einsatz von Somatostatinanaloga protektiv wirkte (p = 0,021). Schlussfolgerung Die supra- oder infrakolische Position der Duodenoenterostomie hat keinen Einfluss auf die Entwicklung einer MES nach Pankreatoduodenektomie. Tritt eine MES auf, so ist der stationare Aufenthalt signifikant verlangert. Eine mogliche Vermeidungsstrategie konnte in der Gabe von Somatostatinanaloga bestehen.
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References29
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Published on Dec 1, 2017in BMC Surgery1.77
Tim R. Glowka5
Estimated H-index: 5
(University of Bonn),
Markus Webler2
Estimated H-index: 2
(University of Bonn)
+ 5 AuthorsSteffen Manekeller12
Estimated H-index: 12
(University of Bonn)
Abstract Background Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD) with published incidences as high as 61%. The present study investigates the impact of bowel reconstruction techniques on DGE following classic PD (Whipple-Kausch procedure) with pancreatogastrostomy (PG). Methods We included 168 consecutive patients who underwent PD with PG with either Billroth II type (BII, n = 78) or Roux-en-Y type reconstruction (ReY, n = 90) between...
Published on Apr 1, 2017in Annals of Surgery9.48
Christian Krautz5
Estimated H-index: 5
,
Ulrike Nimptsch10
Estimated H-index: 10
+ 2 AuthorsRobert Grützmann43
Estimated H-index: 43
Objective:We aimed to determine the effect of hospital volume on in-hospital mortality, and failure to rescue following major pancreatic resections using hospital discharge data of every inpatient case in Germany.Summary Background Data:Several studies have found strong volume–outcome relationships
Published on Sep 30, 2016in Cochrane Database of Systematic Reviews7.75
Felix J. Hüttner9
Estimated H-index: 9
(Heidelberg University),
Rosa Klotz2
Estimated H-index: 2
(Heidelberg University)
+ 2 AuthorsMarkus K. Diener31
Estimated H-index: 31
(Heidelberg University)
Background Pancreatic cancer remains one of the five leading causes of cancer deaths in industrialized nations. For adenocarcinomas in the head of the gland and premalignant lesions, partial pancreaticoduodenectomy represents the standard treatment for resectable tumours. The gastro- or duodenojejunostomy after partial pancreaticoduodenectomy can be reestablished via either an antecolic or a retrocolic route. The debate about the more favourable technique for bowel reconstruction is ongoing. Obj...
Published on Apr 1, 2016in American Journal of Surgery2.20
Mena M. Hanna7
Estimated H-index: 7
(UM: University of Miami),
Leonardo Tamariz24
Estimated H-index: 24
(UM: University of Miami)
+ 4 AuthorsDanny Yakoub7
Estimated H-index: 7
(UM: University of Miami)
Abstract Background The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. Data Sources Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis incl...
Published on Mar 1, 2016in Langenbeck's Archives of Surgery2.09
Tim R. Glowka5
Estimated H-index: 5
(University of Bonn),
Martin von Websky6
Estimated H-index: 6
(University of Bonn)
+ 4 AuthorsNico Schäfer7
Estimated H-index: 7
(University of Bonn)
Purpose Delayed gastric emptying (DGE) is a frequent complication after pancreatoduodenectomy and other types of upper gastrointestinal surgery with published incidences as high as 60 %. The present study examines the incidence of DGE following distal pancreatic resection (DPR).
Published on Mar 1, 2016in Annals of Surgery9.48
Tobias Keck28
Estimated H-index: 28
,
Ulrich F. Wellner22
Estimated H-index: 22
+ 33 AuthorsChristiane J. Bruns46
Estimated H-index: 46
Objectives:To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial.Background:PJ and PG are established methods for reconstruction in pancreatoduodenectomy. Recent prospective trials suggest superiority of the PG regarding perioperative complications.Methods:A multicenter prospective randomized controlled trial comparing PG wit...
Published on Jan 1, 2016in Pancreatology3.24
Dong Qian2
Estimated H-index: 2
(Nanjing Medical University),
Zipeng Lu9
Estimated H-index: 9
(Nanjing Medical University)
+ 10 AuthorsDong Xu1
Estimated H-index: 1
(Nanjing Medical University)
Abstract Background Delayed gastric emptying (DGE) is one of the most troublesome complications after classical pancreaticoduodenectomy (PD) or pylorus-preserving PD. Whether the route of gastroenteric reconstruction has any influence on DGE remains controversial. The aim of this study was to investigate the influence of different types of gastroenteric anastomosis on DGE after PD/PPPD. Methods A systematic search of literature databases (Cochrane Library, PubMed, EMBASE, and Web of Science) was...
Published on Jan 1, 2016in Digestive Surgery1.88
Gaëtan-Romain Joliat8
Estimated H-index: 8
,
Ismail Labgaa7
Estimated H-index: 7
+ 2 AuthorsPierre Allemann8
Estimated H-index: 8
Background: One of the most frequent complications of pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE). The study aim was to evaluate the impact of
Published on Jan 1, 2016in Journal of Surgical Research1.87
Masafumi Imamura11
Estimated H-index: 11
(Sapporo Medical University),
Yasutoshi Kimura36
Estimated H-index: 36
(Sapporo Medical University)
+ 4 AuthorsKoichi Hirata54
Estimated H-index: 54
(Sapporo Medical University)
Abstract Background Delayed gastric emptying (DGE) is a relatively common complication after pancreatoduodenectomy (PD). The aim of this study was to determine whether DGE is affected by antecolic or retrocolic reconstruction for gastro/duodenojejunostomy after PD. Methods A literature search was performed of the MEDLINE (PubMed), Ovid SP, ISI Web of Knowledge, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) and clinical observational studies related to this topic ...
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