Assessment of Different Types of Anastomoses Based on Experience of 200 Pancretoduodenectomies
https://doi.org/10.16931/1995-5464.20151100-105
Abstract
Aim. Comparative evaluation of immediate results of ancreatoduodenectomy taking into account the chosen method
of reconstructive phase and options of pancreatojejunoanastomosis.
Material and Methods. It is analyzed surgical treatment of 206 patients with obstructive diseases in pancreatoduodenal area who underwent pancreatoduodenectomy (PDE) for the period from 1991 to 2014. Reconstructive phase was performed using two techniques: forming pancreatojejunostomy, biliodigestive anastomosis and gastrointestinal anastomosis on single jejunal loop and on individual loops. Choice of pancreatojejunoanastomosis in pancreatoduodenectomy depended on the diameter of pancreatic stump and jejunal lumen as well as on the state of pancreatic parenchyma and main pancreatic duct. Results. Reconstructive stage of pancreatoduodenectomy with anastomoses on the single loop was applied among 198 (96.1%) patients. Developed technique with formation of anastomoses on individual loops was used in 8 (3.9%) patients. End-to-end pancreatojejunostomy was formed among 183 (88.8%) patients, end-to-side anastomosis – in 19 (9.2 %)
cases, anastomosis with gallbladder and pancreatic stump – in 4 (1.9 %) patients. Pancreatojejunoanastomosis with suture line covering using sickle ligament was applied among 4 (1.9 %) patients. Conclusion. Differentiated approach to selection of pancreatojejunoanastomosis reduces number of complications
caused by its incompetence. Pancreatojejunoanastomosis with suture line covering using sickle ligament is preferred in case of soft, “juicy” pancreas and high risk of pancreatojejunostomy incompetence
About the Authors
N. N. Veligotsky
Chair of Thoracoabdominal Surgery and Kharkiv Medical Academy of Post-graduate Education
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Head of Chair of Thoraco-abdominal Surgery of Kharkiv Medical Academy of Post-graduate Education.
A. N. Veligotsky
Chair of Endoscopy and Surgery Kharkiv Medical Academy of Post-graduate Education
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Head of Chair of Endoscopy and Surgery of Kharkiv Medical Academy of Post-graduate Education
S. E. Arutyunov
Chair of Thoracoabdominal Surgery and Kharkiv Medical Academy of Post-graduate Education
Russian Federation
Russian Federation
Cand. of Med. Sci., of Chair of Thoracoabdominal Surgery of Kharkiv Medical Academy of Post-graduate Education.
References
1. Kabanov М.U., Solovyov I.A., Sementsov K.V., Ambartsumian S.V., Yakovleva D.M. Pancreatic cancer – modern point of view. Annaly khirurgicheskoy gepatologii. 2012; 17 (4): 106–110. (In Russian)
2. Liadov V.K., Egiev V.N., Andren-Sandberg A. Mechanisms and prognostik value of the perineural invasion in the pancreatic cancer. Annaly khirurgicheskoy gepatologii. 2011; 16 (1): 92–98. (In Russian)
3. Hirota M., Kanemitsu K., Takamori H., Chikamoto A., Tanaka H., Sugita H., Sand J., Nordback I., Baba H. Pancreatoduodenectomy using a no-touch isolation technique. Am. J. Surg. 2010; 199 (5): 65–68. doi: 10.1016/j.amjsurg.2008.06.035.
4. Perwaiz A., Singhal D., Singh A., Chaudhary A. Is isolated Roux loop pancreaticojejunostomy superior to conventional reconst ruction in pancreaticoduodenectomy? HPB. 2009; 11 (4): 326–331. doi: 10.1111/j.1477-2574.2009.00051.x.
5. Patyutko Yu.I., Kudashkin N.E., Kotelnikov A.G. Different types of pancreatodigestive anastomoses for pancreatoduodenectomy. Annaly khirurgicheskoy gepatologii. 2013; 18 (3): 9–14. (In Russian)
6. Shchepotin I.B., Lukashenko A.V., Kolesnik E.A., Vasylyev O.V., Rozumiy D.A., Priymak V.V., Sheptytsky V.V., Zelinsky A.I. Modification of the reconstruction after pancreatico duodenectomy – physiologic reconstruction. Klinicheskay onkologia. 2011; 1 (1): 30–34. (In Russian)
7. Baichorov E.H., Novodvorsky S.A., Hatsiev B.B., Kuzmin A.N., Baichorov M.E., Gridasov I.M. Pancreato-gastroanastomoz in pancreatoduodenectomy. Khirurgia. 2012; 6: 19–23. (In Russian)
8. Barbavyan G.M. A method of panсreaticojejunostomy in pancreato duodenectomy. Khirurgia. 2014; 8: 28–31. (In Russian)
Review
For citations:
Veligotsky N.N., Veligotsky A.N., Arutyunov S.E. Assessment of Different Types of Anastomoses Based on Experience of 200 Pancretoduodenectomies. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015;20(1):100-105. (In Russ.) https://doi.org/10.16931/1995-5464.20151100-105
Views:
1223
Email this article 