Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy

Vasileios Smyrniotis, MD, PhD; Stavros Parasyris, MD; Georgios Gemenetzis, MD; Ioannis Margaris, MD; Zoe Petropoulou, MD; Maria Papadoliopoulou, MD; Theodoros Sidiropoulos, MD; Dionysios Dellaportas, MD, PhD; Antonios Vezakis, MD, PhD; Andreas Polydorou, MD, PhD; Panagiotis Kokoropoulos, MD, MSc; Kassiani Theodoraki, MD, PhD; Paraskevi Matsota, MD, PhD; Panteleimon Vassiliu, MD, PhD, FACS, FASCRS; Nikolaos Arkadopoulos, MD, PhD, FACS

doi:10.1097/AS9.0000000000000161

Annals of Surgery Open (Jun 2022)

Severity of Pancreatic Leak in Relation to Gut Restoration After Pancreaticoduodenectomy

Vasileios Smyrniotis, MD, PhD,
Stavros Parasyris, MD,
Georgios Gemenetzis, MD,
Ioannis Margaris, MD,
Zoe Petropoulou, MD,
Maria Papadoliopoulou, MD,
Theodoros Sidiropoulos, MD,
Dionysios Dellaportas, MD, PhD,
Antonios Vezakis, MD, PhD,
Andreas Polydorou, MD, PhD,
Panagiotis Kokoropoulos, MD, MSc,
Kassiani Theodoraki, MD, PhD,
Paraskevi Matsota, MD, PhD,
Panteleimon Vassiliu, MD, PhD, FACS, FASCRS,
Nikolaos Arkadopoulos, MD, PhD, FACS

Affiliations

Vasileios Smyrniotis, MD, PhD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Stavros Parasyris, MD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Georgios Gemenetzis, MD: † Hepatobiliary and Pancreatic Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom
Ioannis Margaris, MD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Zoe Petropoulou, MD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Maria Papadoliopoulou, MD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Theodoros Sidiropoulos, MD: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Dionysios Dellaportas, MD, PhD: ‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Antonios Vezakis, MD, PhD: ‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Andreas Polydorou, MD, PhD: ‡ Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Panagiotis Kokoropoulos, MD, MSc: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Kassiani Theodoraki, MD, PhD: § Department of Anesthesiology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Paraskevi Matsota, MD, PhD: ‖ Department of Anesthesiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Panteleimon Vassiliu, MD, PhD, FACS, FASCRS: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Nikolaos Arkadopoulos, MD, PhD, FACS: From the * Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

DOI: https://doi.org/10.1097/AS9.0000000000000161
Journal volume & issue: Vol. 3, no. 2
p. e161

Abstract

Read online

Background:. Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients’ outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients’ outcome. Methods:. The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed. Results:. Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively (P = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively (P = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively (P = 0.02 A vs B+C). Conclusion:. Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

About the journal