ReviewPrevention of pancreatic anastomotic leakage after pancreaticoduodenectomy
Section snippets
Risk factors for pancreatic anastomotic leakage
In order to devise effective measures to prevent pancreatic anastomotic leakage, it is instrumental to identify the associated risk factors. Several factors related to pancreatic anastomotic leakage have been described in the literature. They can be conveniently divided into disease factors (pancreatic texture, pancreatic pathology, pancreatic duct size, pancreatic juice output), procedure-related factors (intraoperative blood loss, operative techniques) and patient factors (age, sex, comorbid
Pharmacological approach to prevent anastomotic leakage
As a high pancreatic juice output in soft pancreas is thought to be an important risk factor for pancreatic anastomotic leakage, it appears rational to postulate that inhibition of exocrine pancreatic secretion in the postoperative period may reduce the anastomotic leakage rate.
This concept was first described by a German group who reported a reduced complication rate after pancreaticoduodenectomy with perioperative infusion of somatostatin [30]. Octreotide, an octapeptide analogue of
Techniques of pancreaticojejunal anastomosis
Various techniques of managing the pancreatic remnant have been studied with the aim of reducing the anastomotic leakage rate. Pancreaticojejunostomy (PJ) is a classical method of reconstruction after pancreaticoduodenectomy. The anastomosis between the pancreatic end and jejunum is performed either as end-to-side, duct-to-mucosa anastomosis, or end-to-end (dunking) or end-to-side invagination anastomosis [43]. In a prospectively randomized study in a canine model, Greene et al [44]
Conclusions
In recent years, pancreaticoduodenectomy has evolved into a safe and effective therapeutic option for malignant and benign diseases of the pancreatic head and periampullary region. Leakage of pancreaticoenteric anastomosis remains a leading cause of morbidity, and at times mortality. Over the past decade, substantial efforts have been invested by pancreatic surgeons to improve the safety of pancreaticoenteric anastomosis using pharmacological or technical approaches. This article provides a
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