Hepato-gastroenterology · 2011
Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy.
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Nojiri Takuya, Misawa Takeyuki, Saitoh Ryohta, Shiba Hiroaki, Usuba Teruyuki, Uwagawa Tadashi, Wakiyama Shigeki, Hirohara Syohichi, Ishida Yuichi, Yanaga Katsuhiko
Аннотация
BACKGROUND/AIMS: The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy.
METHODOLOGY: Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA.
RESULTS: The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF.
CONCLUSIONS: The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.
METHODOLOGY: Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA.
RESULTS: The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF.
CONCLUSIONS: The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.