Surgical innovation · 2022
Pancreatic Ducts Obliteration With Controlled Injection of Onyx®: A Proposal of New Onyx® Pancreatic Ducts Obliteration Scoring System.
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Crafa Francesco, Vanella Serafino, Noviello Adele, Lombardi Giulio, Coppola Bottazzi Enrico
Аннотация
BACKGROUND: The aim of this study was confirm the efficacy and feasibility of Onyx injection for pancreatic stump management after pancreaticoduodenectomy (PD) and investigate a new Onyx® Pancreatic Ducts Obliteration (OPDO) scoring system of pancreatic duct obliteration (PDOb) in patients with high risk of Post-Operative Pancreatic Fistula (POPF).
STUDY DESIGN: We enrolled ten patients undergoing PDOb with Onyx® intraoperative controlled injection after elective PD.
RESULTS: PDOb with Onyx® controlled injection was classified according to the OPDO scoring system in three degrees: complete 5/10 (50%), medium 2/10 (20%) and bad 3/10 (30%). Increased amylase in abdominal drainage was identified in two patients (20%) with a degree II and III, and resolved spontaneously within a week. A "clinically relevant" POPF (CR-POPF) was observed in one patient (10%) with a degree III and none in the patients with degree I and II.
DISCUSSION: We confirm that intraoperative injection of Onyx® is a valid solution in high-risk POPF patients and our OPDO scoring system allows obtain an intraoperative classification of the degree of PDO to prevent the CR-POPOF; furthermore, it may be suggested that the viscosity of the injected product (Onyx®) reduce parenchymal fibrosis.
STUDY DESIGN: We enrolled ten patients undergoing PDOb with Onyx® intraoperative controlled injection after elective PD.
RESULTS: PDOb with Onyx® controlled injection was classified according to the OPDO scoring system in three degrees: complete 5/10 (50%), medium 2/10 (20%) and bad 3/10 (30%). Increased amylase in abdominal drainage was identified in two patients (20%) with a degree II and III, and resolved spontaneously within a week. A "clinically relevant" POPF (CR-POPF) was observed in one patient (10%) with a degree III and none in the patients with degree I and II.
DISCUSSION: We confirm that intraoperative injection of Onyx® is a valid solution in high-risk POPF patients and our OPDO scoring system allows obtain an intraoperative classification of the degree of PDO to prevent the CR-POPOF; furthermore, it may be suggested that the viscosity of the injected product (Onyx®) reduce parenchymal fibrosis.