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Popov A.Yu.

Ochapovsky Regional Clinic Hospital No 1

Lishchishin V.Ya.

Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Petrovsky A.N.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1

Baryshev A.G.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1;
Kuban State Medical University

Grigorov S.P.

Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Baryshev A.G.

Ochapovsky Regional Clinic Hospital No 1

Porkhanov V.A.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1;
Kuban State Medical University

Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures

Authors:

Popov A.Yu., Lishchishin V.Ya., Petrovsky A.N., Baryshev A.G., Grigorov S.P., Baryshev A.G., Porkhanov V.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2021;(2): 14‑19

DOI: 10.17116/hirurgia202102114

Views: 1455

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Table of contents

To cite this article:

Popov AYu, Lishchishin VYa, Petrovsky AN, Baryshev AG, Grigorov SP, Baryshev AG, Porkhanov VA. Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures. Pirogov Russian Journal of Surgery. 2021;(2):14‑19. (In Russ.)
https://doi.org/10.17116/hirurgia202102114

Подписка 2025 (Pirogov Russian Journal of Surgery)
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OBJECTIVE

To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure.

MATERIAL AND METHODS

We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy — 4, right-sided adrenalectomy — 2, gastrectomy with splenectomy — 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach — in 86 (35.5%) cases.

RESULTS

Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B — in 8 (28.6%) patients.

CONCLUSION

Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.

Keywords:

pancreatoduodenectomy
pancreaticoenterostomy
pancreaticogastrostomy
pancreatic fistula
pancreatic necrosis

Authors:

Popov A.Yu.

Ochapovsky Regional Clinic Hospital No 1

Lishchishin V.Ya.

Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Petrovsky A.N.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1

Baryshev A.G.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1;
Kuban State Medical University

Grigorov S.P.

Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Baryshev A.G.

Ochapovsky Regional Clinic Hospital No 1

Porkhanov V.A.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1;
Kuban State Medical University

Received:

17.02.2020

Accepted:

01.03.2020

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